Length of evaluation: 5 MAR - 19 MAR. In-person assessments of random orphanages, IDP camps, and health facilities; focused interviews of Haitian authorities, CDC personnel, USAID representatives, U.S. DOD personnel, WHO/PAHO team leads, senior medical personnel for the International Federation of the Red Cross, senior leadership of the American Red Cross, Senior Medical Lead for World Vision, Ground Medical Lead for Samaritan’s Purse, medical personnel with Doctors Without Borders, a multitude of responders from unaffiliated NGOs and volunteer groups, the Haitian business community, and prominent ex-pat community members.
- The majority of shelter provided in IDP camps consisted of sheets and lumber covered in tarps.
- Although water supply was often chlorinated to levels above US drinking standards, there were several sites identified where the contractor had not chlorinated the water. Further, it was noted by the IFRC that the Bangladesh protocols were not in place. Closed-lid water containers were rarely observed at water distribution sites.
- Hand washing stations were not available in the majority of locations. Hygiene education programs were not implemented throughout.
- Pit latrines were dug, however it was discovered quite quickly that 30 minutes of heavy rain floods the pits and runs raw sewage through the camps. This video, taken by the IFRC shows the damage caused by a typical rainfall.
- CDC’s epidemiology team is focused on supporting the Haiti National Public Health Laboratory and formal medical surveillance. They have deployed SMEs for malaria and dengue control but acknowledged a lack of prioritization for diarrheal disease. There was no debate from their end which was considered a bigger risk of triggering a crisis: diarrheal disease. CDC acknowledged more data to inform surveillance efforts was welcomed, including informal surveillance approaches. While formal medical surveillance, data quality issues aside, provided some information on infectious disease morbidity, public health did not yet have a clear assessment of the leading infectious causes of mortality. They emphasized they work in Haiti at the bequest of the Haitian government and take their lead in public health intervention.
- All of the NGOs or non-public health personnel interviewed indicated they were concerned about diarrheal disease with the coming rains. Seasoned field personnel from MSF/Doctors Without Borders acknowledged formal medical surveillance was not helpful for early warning, and they welcomed the idea of informal surveillance approaches. They were quite concerned about the prospect of diarrheal disease with the coming rains. These thoughts were shared by all other groups encountered.
- There was no evidence of a specific large-scale preparedness plan to respond to epidemic diarrheal disease. There was no evidence of a rapid response capability to deploy countermeasures (i.e. oral rehydration salts, antibiotics, IV fluids) to ‘hot spots’ reporting substantial increases in diarrheal disease. The Promess warehouse was now charging for many of their medications- it was not apparent how well (if) it would function logistically in an emergency response scenario represented by an epidemic of diarrheal disease. It was acknowledged they have a large stockpile of Pedialyte, however it remains debatable how fast that stockpile could be mobilized in the context of an emergency response.
- There was minimal surge capacity in the ad hoc medical grid in PAP. This medical grid is comprised mainly of individuals and groups of responders who in many instances rotate entire teams of medical personnel, including the Chief Medical Officer, every one to two weeks which impairs any attempt to have operational continuity. Sign-off between rotating teams was a challenge. The medical grid functions without situational awareness or anticipation of patient surge and universally asked for situational awareness for infectious disease events. Due to funding constraints, this vulnerability will increase with contraction of available medical resources as responders depart Haiti. The possible departure of the University of Miami team, for example, would close the only functioning NICU in Port-au-Prince and the main PICU used for receiving transfers of critically ill children.
- Based on open source records dating back to the 1950s, Haitian society has rioted after flooding, with cited concerns of lack of shelter, access to safe drinking water and food, and increased risk of disease. These times have occurred within the context of political instability. It may be argued now is such a time. It is a general sentiment on the ground there are discrepancies between funding provided to Haiti versus what was actually made available to the Haitian public. We question what might happen if diarrheal disease reaches uncontrolled levels during the minor rainy season and how the Haitian public might react if children died at levels unusual even for Haitian society.
Praecipio International considers the situation to represent an imminent emergency for Haiti:
- Diarrheal disease is preventable
- Diarrheal disease is a major killer of children if unchecked
- An uncontrolled epidemic of pediatric diarrheal disease, with unusual levels of mortality, may become an important contributing factor to civil unrest
- Immediate deployment back to Haiti to initiate a plan of action is required
- An Emergency Appeal will be presented by Praecipio International