In a Remote Corner of Haiti, Working with Locals to Overcome Cholera

Far from the headlines, the North West department of Haiti continues to battle the unanticipated cholera epidemic which began in October 2010 and has since claimed the lives of over 4,000 Haitians. Almost 12 hours from the capital and logistical hub of Port-au-Prince, the North West is severely isolated and absolute in its beauty. The department has only 30 clinics to serve a population of 663,000 people. The clinics are all understaffed and operate with little funding, if any at all.

International Medical Corps was the first relief agency to provide medical assistance to the area establishing five Cholera Treatment Centers (CTCs) and four Oral Rehydration Points (ORPs) to quickly reach cholera sufferers with vital treatment. In addition, International Medical Corps assessed 16 of the 30 government clinics in the North West department, training medical professionals and Community Health Volunteers (CHVs) along the way. To date, 146 CHVs and 57 health care professionals have been trained in cholera prevention and treatment. These trainees are often the first responders bringing treatment to victims, or victims to treatment, whichever is easier.

The town of Jean Makoute, situated on a peninsula in the North West department, is practically unreachable by road and only accessible by boat. The town has a population of approximately 750 people, 40 of whom have fallen victim to the cholera epidemic. Four have died.  The first time she saw the broken-down community in January Kelly Suter, an ER nurse who has worked with International Medical Corps for five months recounts that it was “love at first sight.” She describes it as vibrant and tragic, with a staggering rate of child malnutrition and very limited opportunities for those that live tucked away in a tiny recess of the Haitian coast, forgotten by almost everyone.

International Medical Corps was the first organization to begin supporting and strengthening the health infrastructure to handle the cholera epidemic. There is no clinic in Jean Makoute and before Kelly’s arrival, the implications of this were disastrous; no supplies or medications were available and the only healthcare professional was a nurse from a nearby village named Inovais who had not been paid by the government health ministry in over two years.  Without the proper training or Oral Rehydration Salts (ORS), Inovais was the only defense the village had standing between them and an unfamiliar sickness which was seemingly choosing its victims at random.

Kelly got to work training community health workers and Inovais on the prevention, identification and treatment of cholera. For months these trainings seemingly had no effect. Changing behaviors proved a formidable opponent – especially reaching local populations with an understanding of the importance of safe sanitation. But over time, the trainings started to work and upon Kelly’s return for a follow-up assessment in Jean Makoute, she was pleasantly surprised to find that the treatment center was in order. Within a few weeks the center and the entire village was cholera free.

The CTC was dismantled, its mission completed, and Kelly began work to train the health care workers on the operation of an ORP scheduled to open in a nearby community. The elimination of cholera in Jean Makoute was a huge triumph, but a fragile resolution which could be easily shattered with a single reoccurrence of the disease. In order to prevent resurgence in the area, a smaller treatment center was established with the capacity to rehydrate mild and moderate cases of cholera.

Upon arrival at the site for the new ORP, Kelly found that not only had Inovais taken it upon himself to begin organizing the unit; but, in a testament to his newly acquired understanding of cholera control, had set up a homemade foot bath and improvised hand-washing station. Her struggle to bring self-reliance to the people of Jean Makoute was coming to an end and a partnership between International Medical Corps and its beneficiaries began.

Community health volunteers continue to monitor the cholera status of nearby villages and Inovais manages any cases that present themselves at the ORP.  Kelly has since moved on to work in other areas, but promises never to forget the fulfillment her work in Jean Makoute brought.

“There comes a point in Haiti when the suffering of this country becomes your own suffering,” Kelly said.  “The ‘tourist’ in you dies, the camera goes into storage and you find yourself no longer watching as an outsider, rather becoming part of the story. Their losses become your losses; their triumphs become your triumphs.  Somewhere along the road I let my heart become attached.  I know when it comes time to move on a part of my heart will always remain behind in Haiti.”

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