Step by step towards a Haiti free from Cholera

HAITI, Artibonite: Stephanie, 22 months, has been sick with diarrhea for the past three days. Worried, her mother Asseline Jean-Louis, 33 years old, has brought her to the health center in Petite-riviere d’Artibonite. From her home in the commune of Dessalines it is a long dusty walk, in 35˚C heat.

“I had six children, once. One of my sons died in 2010. He had diarrhea and vomited. We never knew what had made him sick.” Asseline speaks in a low voice, her big brown eyes look tired having spent the night watching over Stephanie. She is exhausted, yet relieved “I am glad my little one is getting better. Yesterday she was too weak to even sit-up”.

Haiti, Artibonite, 25-09-2014, Stephanie and her mother at the Cholera treatment centre in Petite-rivere d’Artibonite.

©UNICEF Haiti, Cornelia Walther Haiti, Artibonite, 25-09-2014, Stephanie and her mother at the Cholera treatment centre in Petite-rivere d’Artibonite.

On their arrival at the health center, a rapid diagnostic test confirmed the suspicion that cholera was the cause of her acute watery diarrhea. Immediately, the little girl was placed in the Cholera Treatment Center (CTC) that is located at the health center. She was put under intravenous treatment and given oral rehydration solution (ORS) for rehydration. Even though Stephanie doesn’t particularly like the taste of the ORS, she gulps it down, feeling that it helps make her feel better.

Since the beginning of the Cholera outbreak in October 2010, there have been 727,527 suspected cholera cases in Haiti, with 8,854 reported cholera related deaths up to 25 January 2015[1]. Currently approximately 765 new cases are registered per week – every hour 2 people get sick. The capital Port-au-Prince, followed by the Departments of Centre, North and Artibonite continue to have the highest cholera attack rates, accounting for more than 80 percent of all suspected cholera cases in 2014. However, there is reason for optimism. Concerted national and international efforts have resulted in a steady reduction in the number of people affected by, and dying from, cholera over the last three years. Specifically, the number of suspected cholera cases continues to decrease, from 352,033 cases in 2011, to 101,722 cases in 2012 and 56,174 cases in 2013.

From January to December 2014, there has been more than a 50 percent reduction in the number of suspected cases compared with the same period of 2013.

When detected and treated early, severe dehydration from cholera is not a death sentence[2]. Had Stephanie been left alone her smile might have vanished forever. Yet the quick, simple and efficient treatment of ORS, antibiotics and intravenous fluids at the CTC was able to restore her health in a relatively short period of time. Good hygiene, safe water and early access to treatment are of the essence in the fight against the disease.

Though enough water is available in Haiti, it is estimated that just over one in three people (or half of rural Haitians) do not have access to safe drinking water and nearly two in five (38 percent) people living in the rural areas practices open defecation[3].

The Government of Haiti signed the ‘A Promise Renewed’ (APR) in 2012, committing hereby to save a maximum of children from preventable causes. In 2013 the Government launched a 10 year plan for the elimination of cholera to address the cholera epidemic.  It includes both cholera response activities and longer term elimination activities that aim to change the status quo through the extension of water and sanitation infrastructure to rural areas. In July 2014 the Prime Minister, together with UN Secretary General Ban-ki Moon launched a five-year national sanitation campaign, aiming to support communities in high risk areas to set-up simple yet efficient latrines.

From the beginning UNICEF has been working hand in hand with the Government and communities to make the right of every Haitian child to health a tangible reality. Besides technical and financial support given to the Minister of Health, six partner non-government organizations (NGOs) are deployed across the 12 departments of the country to support MSPP, facilitate strong coordination and constant follow-up of critical domains. The aim is to ensure that all suspected cholera cases are responded to within 48 hours through mobile teams, delivering an emergency hygiene package, conducting sensitization campaigns and household decontamination visits.

Furthermore, as part of an integrated package of activities that includes community outreach on cholera prevention, hygiene promotion and improvements in water infrastructure, UNICEF supported the Government of Haiti to vaccinate approximately 102,250 people in 2013 and 190,142 people in 2014. A national technical committee, led by the Ministry of health and supported by UNICEF, WHO/PAHO and CDC was established in late May 2014 to design and coordinate the campaign. The campaign targeted high-risk cholera areas to try and disrupt the chain of transmission during the next dry season which will help to reduce the number of cases, especially during the critical wet season.

©UNICEF Haiti, Cornelia Walther

©UNICEF Haiti, Cornelia Walther Haiti, Artibonite, 25-09-2014, A team of health workers plans their day. On the way they explain to a group of students good hygiene practices.


Treatment can save lives, and hygiene can prevent disease. Little Dudley, who is the same age as Stephanie got lucky. His mother Angeline, 19 years, just received a sensitization visit from Action Contre la Faim (ACF), UNICEF’s main NGO partner in Artibonite. Together with her extended family she participated in a hygiene information session and received a large package of Aquatabs for water treatment over several months.  “It’s good to have the tabs and to know what to do with it. Dudley is my only son and I am happy that I have the means to protect him.” Angeline says. When she smiles her whole faces lights up. A light that might eventually shine all across the country.

[1] Figures as published by the Haitian Ministry of Public Health and Population (MSPP)

[2] 75% of people with cholera are asymptomatic (no symptoms). Of the 25% of people who will get symptoms, only ~5% will have severe cholera that will lead to death if left untreated. Or up to 50% of infected people could develop severe dehydration with high mortality risk if left untreated


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