Haitian Refugee Camps, Cholera, Social Media, and Senator Marco Rubio--October 2015
Cholera Victims–June, 2011 (Photo by John Carroll)
Summary:
The refugee camps in Anse-a-Pitres shouldn’t exist because the people in the camps should have never been threatened or deported from the Dominican Republic in the first place. And the camps need to close as soon as possible because they hold no meaningful promise for human beings.
The Dominican and Haitian governments need to provide care and relocation for the tens of thousands of “stateless” people living in the camps up and down the Haitian-Dominican border.
These camps are a breeding ground for infectious disease. For the past five years Haiti has been host to the largest cholera outbreak in the world. If cholera strikes the camps it will be devastating.
Experts from multiple disciplines use the internet and social media to provide solutions precisely to help these people in the camps. But their ideas need to be implemented now and not after catastrophe strikes.
Several weeks ago while walking through the refugee camps in Anse-a-Pitres some scary thoughts went through my mind.
I wondered about the chaos and death that would occur if cholera struck these camps. There are about 3,000 people in the camps now. And I saw people drinking directly out of pipes from river reservoirs near Camp Cadot #2 without adding any chemical to the water to purify it.
Cholera is a disease caused by a bacteria that is spread through food and water that is contaminated with infected human waste. It is more common in areas without access to regular sanitation or waste disposal services. Many people in Haiti’s rural areas have no access to safe water, and only 25 percent have access to health care services, the government reports.
Cholera presents with diarrhea, vomiting, muscle cramps, rapid heart rate and low blood pressure. The U.S. Centers for Disease Control and Prevention reports that one in 10 cases is considered severe and can lead to renal failure or coma. If left untreated, the disease can lead to death from severe dehydration.
Haiti’s Ministry of Health reported that cholera has infected 22,511 people through Sept. 30 this year, resulting in 185 fatalities. In the past week, the southeastern part of the country reported 268 cases and the refugee camps in Anse-a-Pitres are as far southeast in Haiti as one can go. The country reported more than 745,000 cholera cases between October 2010 and August 2015; approximately 57 percent of these patients were hospitalized and 8,965 people died from the disease.
I recently contacted Stuart Leiderman, a New Hampshire specialist in public health, environmental refugees and ecological restoration of damaged homelands. Over the years, Stuart has served as a friend and advisor to several Haitian-support organizations. We are both members of the online Haiti Epidemic Advisory System [HEAS].
During the last few weeks we have exchanged numerous e-mails regarding the refugee camps on the Haitian-Dominican border. Below is a thread of e-mails and social media interactions discussing the situation. The internet allows us to communicate in real time quite effectively with experts from all over the world.
However, the ultimate goal is not to just communicate with brilliant minds but to incorporate their ideas and put their advice to use BEFORE there is a public health catastrophe in these camps…such as cholera.
Cholera Victim–2011 (Photo by John Carroll)
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E-mail thread between Stuart Leiderman and John Carroll regarding the refugee camps on the Haitian-Dominican border–
October 19, 2015
“Hi, Robin [with copy to Susie]:
[Robin Hamill and Susie Krabacher are leaders of Mercy & Sharing <haitichildren.org> which is a Haitian-support organization based in Colorado. Through their research and advocacy work, members of Congress have opened their doors to them, including Florida Sen. Marco Rubio who convened a hearing in July on U.S.-Haiti relations. www.foreign.senate.gov/hearings/overview-of-us-policy-towards-haiti-prior-to-the-elections-07-15-15]”
Thanks for a chance to relay a message to Sen. Rubio’s staffer. At the moment, two matters loom large to me, with correspondence and documentation below and attached:
I. CHOLERA
Recent U.N. forecast and GOH “red alert” about possible resurgence of cholera, especially in the border region where it will victimize both storm-hit residents and recent border refugees living in camps who are physically weak and vulnerable. In one scenario, if refugees flee westward away from cholera, some who may be infected may carry cholera to other communities. approaching rainy season worsens the threat. There is little sense of tight, high-profile, coordination response, adequate staffing, equipment and supplies. UNOCHA reports receiving none of the millions of dollars appealed for the border region crisis. Despite it being an obvious refugee situation – those who have fled persecution in the D.R. who have never stepped foot in Haiti before now – and despite seeing a photograph of a yellow flyer, none of us have heard of UNHCR being actually on the scene and taking asylum requests, nor have we heard of anyone being granted asylum/refugee status, protection and resettlement to safe places elsewhere in Haiti or in another country. UNHCR’s Western Hemisphere office is in Washington, D.C., so accessible to Congress. In addition to Dr. John Carroll [contact information below] another personal contact regarding the camps in Anse-a-Pitres is Kara Lightburn. Kara told me she expects to return to Haiti October 22; her phone there will be…. I’ll copy this to both John and Kara. They’ll know others who can be interviewed.
II. ELECTIONS
Continuing and perhaps worsening violence with only a week before Presidential primary/Parliamentary runoff elections. Reports of killings, palpable fear and fleeing from neighborhoods. Uncertainty of causes, but suspicion of political motives and intimidation. Unknown national and international preparation to secure polling stations, ballot boxes, vote counts and reporting. Among Haitian-Americans, they are in the dark about how American money and influence is being used, worsened by vague assurances from, for example, Kenneth Merten recently at a town meeting in Little Haiti, Miami. The hackneyed expression “free-and-fair-elections” has become meaningless because no officials are defining it, nor using any metrics to judge the August 9 election and being prepared to score October 25th. I drafted the survey form below for this purpose. Meanwhile, nothing substantial and public seems to be being done, telegraphed or demonstrated to avoid the obvious interference and corruption of the 2010 Haitian elections and worries that it will re-occur, i.e. that another president will be “selected” rather than “elected,” and not by Haitian voters. The Haitian grassroots watchdog, OCAPH, just held a candidates forum on the free-and-fair theme, but no evidence of answers on what they will do or are pledged to do. I understand that some political parties were linked to violence on August 9 and the government subsequently barred some of them from the rest of the election season.
How’s that for a start? I’m here if you’d like to call.
‘best,
Stuart
leiderman@mindspring.com
= = = = = = =
CHOLERA
From: leiderman@mindspring.com
To: haiti-epidemic-advisory-system@googlegroups.com
Subject: [HEAS] leiderman fwd carroll: preparing for cholera, again?
Date: Oct 19, 2015 1:19 PM
I’ve been in touch with Dr. John Carroll [physician from Peoria, Illinois haitianhearts@gmail.com] before, during and after he recently worked in the refugee camps in Anse-a-Pitres in Haiti’s far southeast corner. He approved my posting his observations and suggestions, and our string of correspondence per below. I hope this encourages more reports from the field.
The attached OCHA summary from late-August identifies the cast of characters at various crossing points, but I don’t have their direct contact information and I don’t know who’s currently working where. In July, per attached, MSPP requested “all hands on deck,” but I don’t know what’s come of it or if it’s sufficient.
Feel free to foward to others.
thanks,
Stuart Leiderman
leiderman@mindspring.com
– – – – – – –
On Mon, Oct 19, 2015 at 9:32 AM, John Carroll wrote:
Stuart,
Here are some thoughts re cholera at the border region in Anse.
I have worked at five Cholera Treatment Centers (CTCs) in Haiti during the last five years and these thoughts are just what I have learned while on the job. Nothing academic here.
My ideas/thoughts here are “free association” and I hope they make some sense.
1. Location: Need a location for cholera patients from Camps 1 and 2. Possibly the empty MSPP hospital in Anse. The sick patients would have to get from the camp to the hospital which is about 3 miles away. How would they get there? There did not seem to be much in each empty room at the hospital. Cots would have to come from somewhere. And where would the waste be disposed. There are strict guidelines for this and we could not dump all the excrement in the middle of downtown Anse.
2. MSPP nurses would be the best to staff the cholera clinic in Anse. Where would they stay? They need to cook for themselves and do their own wash. They need time off too. I have worked with MSPP nurses in CTCs who were paid about 80 dollars US per month by the Haitian government. These nurses would have to be brought into from Port or somewhere. An exhausted nurse in the middle of the night will mean dead patients as the sun comes up in the morning because their IV’s have not been running.
3. Would the mayor and dignitaries in Anse even want these refugee camp people with cholera invading their city to be cared for by the MSPP hospital?
4. IV fluids, IV tubing, angiocaths of all different sizes need to be on site with a constant supply brought in all the time for back up. Just one sick patient can go through dozens of RL over the course of 3 days. And the nurse needs to have energy to constantly keep the IV’s open, restart IV’s, re hang empty IV bags that have just run in, etc. It is very time and labor intensive. An empty bag hanging over an obtunded patient with cholera does not help that much.
5. Would the DR provide some of the IV fluid and setups brought in from Pedernales to sustain people in the camps who have just been forcefully or voluntarily deported from the DR? Seems kind of like a Catch-22 scenario.
These are just a few simple thoughts from me. But cholera is a simple disease to treat if the chain is not broken from location, supplies, nurses, etc. This is not heart surgery.
Please give me some quick thoughts when you get time.
Thanks,
john
On Sun, Oct 18, 2015 at 1:59 PM, John Carroll wrote:
Stuart, here is the e mail I sent you this morning. It may have gone to HEAS. It was great talking to you too. I have read your article. It is really good. It needs some definite answers to your good questions. The Haitian government really needs to step up….but I doubt they will.
Stuart,
Do you have any direct evidence that there is cholera in Anse now?
If cholera hit the two camps where I was in Anse, it would/could be a big disaster. I doubt there is much RL in the area. And nurses are key to keeping IV’s running. The camps are terrible places and I didn’t see much of anything in the MSPP clinic and the vacated government hospital in Anse that would help with cholera. I did see people drinking straight out of pipes from the river reservoir with nothing added to it like clorox or aquatabs.
Coming in from the DR side to help a cholera outbreak in Anse seems like the smart thing to do. Anse is so isolated. It took me 7.5 hours to get there from Port. A speed boat will take you from Jacmel to Anse for $250 US. Takes a couple of hours. A big boat could bring in lots of RL from the Haitian side to Anse. Could bring in lots of nurses too but the nurses need somewhere to stay/sleep.
A new can of worms opens up if cholera hits the refugee camps regarding this whole border “problem”. Would the DR supply RL for the people it just deported? Would the border be more patrolled?
Let me know your thoughts please.
john
On Sun, Oct 18, 2015 at 1:17 PM,
Stuart wrote:
Hi, John (with copy to Dr. Castor) and thanks for your conversation just now. Below is our draft article about border region health concerns that Aldy intends to bring to Le Nouvelliste newspaper: his French version, my two insertions re cholera, and my original English draft.
Being that you’ve recently been to Anse-a-Pitres and reported on the condition and needs, and that the article is meant to convey the physician’s view of the border crisis, I think it’d be great if you added something to it as an additional co-author. The newspaper might even publish some of your illustrative photos from the scene. Your point about needing nurses on-site to tend to cholera patients, drip tubes and toilets is important; we ought to add that to the article. The danger of infected people fleeing the camps out of fear and possibly spreading cholera to new locations after another outbreak, is also important.
I’m sure Dr. Castor will appreciate hearing from you. He just returned to Haiti and will be there for a week or so; e-mail aldyc@att.net and Skype aldycastor.
I’ll be here. Thanks for everything!
Because Anse-a-Pitres was named in the cholera alert, I’ll also copy Kara and Marciana in New York so that they consider how to get the necessary medical supplies out there either from Haiti or the D.R., how to pay for them and where to safely store them. I think Kara said she planned to fly back there on the 22nd.
‘best,
Stuart
leiderman@mindspring.com
Skype stuart.leiderman
– – – – – – –
From: John Carroll
To: Stuart Leiderman
Subject: john carroll sunday AM
Date: Oct 18, 2015 12:28 PM
Stuart,
Are you online now? If you are please send me your phone number or call me…I want to talk to you if you have a few minutes about your post this AM on cholera in Haiti. Thanks.
john
– – –
On Sunday, October 18, 2015 at 3:18:26 AM UTC-5, leiderman wrote to the Haiti Epidemic Advisory Group–
Dear Group:
http://bioprepwatch.com/stories/510643265-red-alert-issued-in-haiti-following-cholera-cases follows on the heels of the OCHA alert https://www.humanitarianresponse.info/en/operations/haiti/document/ocha-haiti-humanitarian-bulletin-54-september-2015-engfr per below. It looks bad, and could use some field reports from HEAS members.
For Anse-a-Pitres, and despite its difficult accessibility from the Haitian side [ssistance from the DR side might be quicker], urge help to stockpile Ringer’s lactate solution, oral rehydration packets, plenty of gloves and disposable sheets, water filter systems, etc. There may be cholera isolation tents around, left over from the original outbreak.
Thank you,
Stuart Leiderman
leiderman@mindspring.com
– – – – – – –
Risk of a cholera outbreak in the camps – There is also a growing concern about the possibility that the cholera epidemic could affect the returnees/deportees, especially in Anse-a-Pitres. In these camps, where thousands of people live, the hygiene conditions are inadequate; access to clean water is limited and health infrastructures are scarce. In most of these camps, only three latrines serve about 500 people. Residents of neighboring communities and camps continue to drink water from sources of doubtful quality and the amount of available water is insufficient. Many people, especially children, have contracted diseases related to hygiene and water. Cases of diarrhea and skin infections are reported.”
————
August 31, the International Organization for Migration reported it has received none of the $10 million appeal to care for border refugees.http://humanitariancompendium.iom.int/haiti/2015
September, the U.N. Office of the Coordination of Human Affairs [OCHA] reported “Bi-national situation in Anse-a-Pitres nearly 3,000 people need urgent humanitarian assistance” https://www.humanitarianresponse.info/en/operations/haiti/document/ocha-haiti-humanitarian-bulletin-54-september-2015-engfr OCHA stated, “There is also a growing concern about the possibility that the cholera epidemic could affect the returnees/deportees, especially in Anse-a-Pitres. In these camps, where thousands of people live, the hygiene conditions are inadequate; access to clean water is limited and health infrastructures are scarce. In most of these camps, only three latrines serve about 500 people. Residents of neighboring communities and camps continue to drink water from sources of doubtful quality and the amount of available water is insufficient. Many people, especially children, have contracted diseases related to hygiene and water. Cases of diarrhea and skin infections are reported.”
——–
Article written by Dr. Aldy Castor and Professor Stuart Leiderman–
Authors:
Aldy Castor, M.D. aldyc@att.net President, Haitian Resource Development Foundation (HRDF) Director, Emergency Medical Services Haiti Medical relief Mission, Association of Haitian Physicians Abroad (AMHE)
Stuart Leiderman leiderman@mindspring.com Environmental Response, USA
Original English draft:
DRAFT, “KNOCKING ON HAITI’S DOOR”
July 20, 2015
With a tip of the hat to Bob Dylan a lot of refugees, deportees and forced migrants from across the border are suddenly “knocking on Haiti’s door.” This is a twist of fate because for generations, Haitians knocked on the D.R.’s door for a little work and cruel hospitality.
Now suddenly, Dominican citizenship revisions have made thousands of people stateless, homeless, unemployed, unwelcomed and afraid. Among them are children and grandchildren going back almost a hundred years. In emergency response language, this would be a “mass casualty event.” We expect heavy human traffic at the border, an involuntary westward exodus with unpredictable consequences.
Preparation and response are essential. As in all emergencies, there are three levels of action – policies, programs and projects: leaders must make and announce policy, governments must make and coordinate programs, and communities must design and implement projects. In all of them, there are two categories, administrative and support. Administration includes a) recognition, b) identification, c) budgeting, d) staffing, e) international relations, and f) paths to citizenship. Support includes a) welcome, b) communication, c) life support, d) resettlement, e) work and f) education.
As a physician, my first concern and duty is to maintain and improve health. In this, I am joined by thousands of native Haitian doctors and nurses, Haitian-American health professionals such as members of the Association of Haitian Physicians Abroad, civil servants such as from the Ministry of Public Health and Population [MSPP], and charitable development organizations such as Kellogg Foundation whose money helps reduce maternal and infant mortality.
Together, we must be a match for the problem. At risk could be an estimated two hundred thousand worried people, “your tired, your poor, your huddled masses yearning to breathe free,” in the words on the Statue of Liberty. They have already begun to arrive, crossing dozens of locations along the border. Next, there could be a massive sudden pulse or a prolonged wave over several months. Either way, medical attention must begin as soon as these people pass into Haiti.
Imagine the hot Sun, a dusty road, a long line of unarmed, dark-skinned infants, youths, adults and seniors who are thirsty, hungry, suffering from exposure, speaking mostly Spanish. Some may be near collapse, some may be contagious. Shade, food, water, diapers and painkillers are in demand. Will there be a coordinated, thorough and compassionate medical response? Will physicians and interpreters meet, interview and examine everyone, take blood and urine samples, give protective inoculations, write prescriptions, mend cuts and bruises, bandage wounds, clean infections? Will pregnant women be offered pre-natal care? Will they know where to go when the time for birth arrives? Will personal hygiene and first aid kits be distributed to everyone? To prevent contagion – for example a repeat of cholera – how many will be held in quarantine? One-tenth? One-third? One-half? All? How many days will be sufficient? After that, will they be sent to camps, or expected to “self-settle” throughout the country, or given political asylum as genuine refugees?
On July 15, the Minister of Public Health and Population issued a national and international communique on the border crisis, requiring medical responders to contact MSPP and all Haitian citizens to exercise vigilance. http://www.mspp.gouv.ht/site/downloads/Communiqué de presse deportes 15 juil 2015.PDF The intention is to bring all responders under a single umbrella, Of note, there are two-hundred sixty-five health organizations currently registered with MSPP, including my Haitian Resource Development Foundation per http://mspp.gouv.ht/newsite/mspp_liste_ong.php All together, we could make a considerable difference, but coordination orders have not yet been received. Meanwhile, thousands of refugees are knocking on Haiti’s door.
———
John A. Carroll, MD
www.haitianhearts.org
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