When deciding what the critical operational issues are when covering this epidemic, we offer our perspective as operational biosurveillance analysts with years of experience:
1. What is the status of the community medical infrastructure? Is the community medical infrastructure comprised of one hospital, one hospital and multiple feeder clinics, multiple hospitals, etc? Are they (individual facilities and the medical grid as a whole) able to ingest patients and manage them appropriately?
2. What is the level of community expectation for access to medical care? Is there any sign of social outcry due to preventable loss of life?
3. Has medical materiel supply been overcome by demand? This also implies whether there is an ability for agile deployment of response teams backed by appropriate funding.
4. Is there available laboratory capacity to accurately diagnose cholera? How does laboratory confirmation play into deciding mobilization of life-saving medical intervention be it in the form of supplies or personnel?
5. What is the anxiety level of the community (note this is different than the outcry mentioned in bullet #2)? It is not enough to report simply there is "panic". What behaviors that are different than routine daily activities are people engaging in? For instance, are people mass migrating out of the main epidemic zone in Artibonite (the answer is yes, with tremendous implication of risk to Port au Prince). We consider any report of sudden mass evacuation of an IDP camp or settlement, for instance, to be worthy of immediate scrutiny.
We hope this is of help to you during this time of crisis.
James M. Wilson V, MD
Haiti Epidemic Advisory System (HEAS)
Washington-Houston-Port au Prince
Praecipio International is a charitable non-profit organization devoted to the promotion of operational biosurveillance worldwide.