Haiti cholera assessment #2

When you think everything is under control and is going smoothly, something grabs your attention and takes over. An 8 year-old boy did that today. We went to 3 of our projects to look at a group of children who were identified last week as needing a more thorough "look-see". Jack and Edrice had done a very nice preliminary assessment of the children and identified those who looked moderately or severely ill and dehydrated. It was my turn to look at them now. Jack and Edrice had also handed out chlorine, soap, and education material to get the projects up to speed on cholera prevention. And from what I saw it was working. We saw about 100 children from the 3 projects, referred 14 of them for further care and transported 1 child urgently to the cholera treatment center. He was the one who got my attention. 8 years old but looked like he was 5, severely dehydrated,but also severely malnourished, more than likely from being ill for a while. He was lethargic, pale, weak pulses, and to be frank, looking to collapse permanently in just a few more hours. We rushed him to the CTC and he was immediately treated after I consulted with the physician there. By the time we left, he was getting IV therapy and was on a comprehensive fluid resuscitation protocol that the local physician and I put together. We also planned out a 1 week nutritional rescue program for him that would insure his recovery. He will do well.

We established a relationship with 2 hospitals that will take our children and care for them when needed. We meet with several physicians and discussed long term plans for cholera prevention and intervention. Cholera is here to stay for awhile, but I will tell you, that our projects are way ahead off the game, by having the chlorine, soap, and education in place. I am very encouraged with what I've seen and with what we've been able to do for our children.

As we move through the country, there is still evidence of the toll that cholera takes. I came across a young woman sitting in a wheel chair, an IV In her arm, and a blank stare. She was dripping the classical rice water stool from her wheel chair, unaware of the pool of diarrhea that she was leaving below her. People walked around her. I did too, but stopped briefly to touch her arm, to tell her that I was not ashamed to be there next to her, to let her know that she too should not be ashamed. I turned and left and knew that she may not make it. I could only hope that she felt my touch and knew that I was not afraid of her or her illness. Cholera in Haiti carries a stigma, no different than AIDS did many years ago, with people afraid to be near those affected. She deserves more than that.

I am so thankful for what we've done in our projects to prevent and avoid what I saw in the CTC tents. We move on tomorrow to 5 more of our projects. I am ever thankful for what we have in our lives, no matter how bad things may seem for us. Look at the pictures above. I think you'd agree.

In all things give thanks,
David

Haiti Cholera assessment pictures

Pictures of cholera treatment center.

Haiti Cholera Assessment #1

(Hard time up loading pictures)

There is never a shortage of things that need explaining and what is happening in Haiti is one of them. The election for a new president was yesterday and there were 19 candidates running,15 of whom have now said that there has been fraud and the announcement of the winner will be within the next 24 to 48 hours. Demonstrations and perhaps even worse is expected. And here I am. Assessing what the cholera epidemic is doing to our children in our projects. There is never a moment in this country that is without hardship. Poverty, and earthquake, TB, slow recovery, and now this, a cholera epidemic. It's been said that even a mouse will kick an elephant when it's down. Well,kick away. This elephant, this country is staying down for a while.

We have 15 projects here in Haiti, with over 1600 children under our care. Jack from MoM HQ's and Edrice our country coordinator have been busy this week. They got supplies from the DR, visited all the projects, did a quick assessment of the children using an algorithm table I developed and began teaching the projects how to prevent cholera. I arrived several hours ago, and within 15 minutes of landing, was at the Justinian Hospital meeting with physicians that I have known, Nate from Konbit Sante, and off to a cholera treatment center (CTC). Within 2 hours we established the referral pattern for our sickest children and collaborated with the Baptist Hospital in Carrefour La Mort run by the Haitian Hospital Appeal. A CTC was being established there. I made quick rounds and saw extremely dehydrated and sick patients getting treatment. Rows and rows of them. A triage system is established with "A" for oral rehydration, "B" for oral and IV rehydration and observation,and "C" for seriously ill and dying patients. Chlorine basins are everywhere. Our shoes are sprayed with chlorine when we leave the area. Patients are coming by the hundreds.

But what about our children and the projects? I begin a comprehensive assessment of all projects tomorrow. I wanted to have the referral process in place before I went out so I could be able to send children somewhere if I needed to. Here is what we are doing for the projects:

1. Each project has 2 people identified as "prevention" specialists who are being trained by us to teach hand washing, hygiene, waste disposal, and assessment of signs of dehydration.
2. Each family (1600 of them) have received a gallon of chlorine for their water, enough to last one month with more to come
3. Each family (1600) have received 5 one pound blocks of soap
4. Each project now has a water filter
5. Each project has enough ORS packets to treat at last 50 children until they can be sent elsewhere
6. We will be assessing latrines, sewage, and waste disposal next

It's been a long day. I am hoping for calm tomorrow with no civil unrest. We have so much more to do. I feel like time is slipping away, and I wonder if it will ever slow down. I will rest little tonight, knowing that there are many who will slip away. The humiliation of laying in your own diarrhea, dehydrated, and passing away, is what I see even with my eyes closed. I wonder what they see.

In all things give thanks,
David

Haiti emergency relief trip

I’m leaving for an urgent trip to Haiti in a few days. Jack from MoM is arriving today. Several of our children are critically ill, some have passed away, parents, church members, and pastors are all affected. We are urgently traveling there to assess and assist. Jack, myself, and our wonderful partners on the ground in the DR and Haiti are going to do our best to bring some semblance of health care and prevention to those who are suffering. There is civil unrest, riots, an election coming up and danger. I know that we are protected. Without Him we are nothing.

For the past week, Jack and I have been planning, implementing and assessing what our intervention can accomplish. We have ordered a lot of supplies from the DR that are being transported to Haiti. Here is what we are doing:

1. Evaluate all the projects for:

· Water sources, supplies, cleanliness, utilization and potential for wells and/or filtration systems: we are taking a supply of water filtration systems with us

· Hygiene and sanitation protocols

· General health conditions of the children and families

o Nutritional

o Infectious

o Document number of people with cholera

o Degree of illness

2. Ongoing treatment

· Plans for referrals to hospitals or clinics for medical care

· Meet with our local MD who we are working with to coordinate efforts

· Visit Justinien Hospitals and Milot Hospital

o Evaluate their ability to care for more patients

o Evaluate supply needs

3. Evaluate collaborative efforts with Konbit Santé and the local hospitals

4. Establish a plan and priorities for our January medical team dependent on the findings from this trip

5. Reinforce aggressive education to prevent any more child deaths.

a. Invite all mothers/children to come to the projects each day:  They will get a bowl of porridge and ORS

b. Training for making ORS, hygiene, sanitation, water purification will be done at separate teaching stations that families will rotate through so that each mother/family can clearly see the importance of each and not get overwhelmed.

6. Following the list of registered children each project will keep attendance records each day and follow up with the families that haven’t come.

7. Home visits will be conducted frequently to follow up on assessing sanitation, use of products, and additional education.

8. Any child/family member identified as being at risk in any of the above steps will be either moved to the project for observation and ORS treatment or taken to clinic/hospital for IV treatment.

We have a lot to do. We are anxious, yet comforted by the fact that we will be doing what we know He wants us to do. I’ll be posting to the blog and tweeting as I can starting on Sunday evening (November 28^th). In the meantime, during this time of thanks, remember what you have and what you don’t have, and…

In all things, give thanks.

David

Update November 2010

A team leaves in a few hours for Cambodia. I unfortunately will not be going with them, so there will be no blogging at this site. Michael, our pastor will be blogging from his site http://developingworkers.com so please follow them there, and on our Medical Mercy Facebook page. This will be a very special trip.

 

Some of you may be wondering about Haiti and what Medical Mercy and Mission of Mercy has wand will be doing there. Medical Mercy is taking a team to Haiti on January 2, 2011 and we’ll be up north near Cap Haitian and in the areas most hit by the refugees and in our projects. We’ll be working at an orphanage as well. When the cholera endemic hit, we put in to place an aggressive educational and prevention program. Here is what we know and what we have done so far:

 

•             The two areas in the North where the cholera is present is Cap Haitian and Lembe

•             MoM has gathered all the data on the living conditions of registered children.

•             Each partner has identified two members in there church that will help with the follow once the training is done.  They will make sure that each household understand what the necessary steps to prevent cholera.  They will also make sure that the items MoM will provide is being used properly.

•             MoM has identified who is using the water filters and the ones that are not using.  Additional water filters are being purchased and will be sent.

•             We have a doctor there  who is  helping with the training and has also with him enough oral rehydration kits to teach them on how to prepare and when to use it. 

 

In January we will be working on education, prevention, nutritional assessment, assessing residual complications of those affected by cholera, and doing ongoing medical care. I expect that we will be busy.

 

Pray for the Cambodian team. They have a long way to travel and a lot that will be done. Be with them as they do what they do for whom it is most important.

 

In all things give thanks,

 

David