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Responding to the cholera outbreak in Petite Riviere, Haiti

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Interview with field coordinator Aurelie Ponthieu

Every day, Médecins Sans Frontières (MSF) staff are treating more than 100 new patients with cholera-like symptoms in Petite Riviere, a city in the Artibonite River region, north of Port-au-Prince. Last week, an MSF team arrived at a government-run health center that was in need of support and immediately began treating patients with symptoms including watery diarrhea.

Confirming cholera requires lab testing, but the treatment for cholera and watery diarrhea are the same, beginning with rehydration.

On October 27, 156 new patients were admitted to the center, and 177 were discharged. At the end of the day, staff were treating 179 patients.

Aurelie Ponthieu is the MSF field coordinator in Petite Riviere. She explained what the team is doing now and what their concerns are as the outbreak continues.

How is treatment progressing in Petite Riviere?
“The treatment is working fine and we see a lot of improvement in the patients since we came here five days ago. We arrived in a very overcrowded, overloaded health center that we came to relieve, and there were many patients needing treatment.

“Today, October 26, we discharged 212 patients—that’s a lot and it’s good because people are coming to the medical facility and they usually recover in two days. On average, we have been receiving about 150 new patients every day and today was the same.”

Do you have a sense of whether the outbreak is slowing down?
“It is hard to say whether the situation is improving or deteriorating because we’ve only been here for five days. When you open a treatment center, people start coming and we don’t know where they were before. So it’s hard to have a good analysis at the moment. We also heard today that in the rural areas other health centers are receiving cases as well.”

Are patients coming in early enough to get treated?
“We have a bit of everything. We have people coming at the very, very early stage, which is good. But we also have people coming too late, meaning in very severe condition. Not many—there have been fewer deaths since we have been here. But those who come at a very late stage, you have to take care of them quickly.

“Mainly, watery diarrhea and cholera treatment are about hydration. Normally, if the treatment goes well and the person has no complications, in two days the person is cured and can go home. It’s very quick.”

How is MSF working with the Ministry of Health and with other organizations in Petite Riviere?
“We came here to support the Ministry of Health—the health center was treating these patients when we arrived. They were overloaded because they were lacking staff and supplies, and did not really know the protocol, since cholera is relatively new in Haiti. It has not been here for at least 60 years. So of course they needed help.

“We are working in collaboration with the ministry and with Partners in Health, another non-governmental organization, which was supporting the health structure before the outbreak. So we have partners here and the collaboration is good.

“Our main concern at the moment is that this outbreak, with the resources it demands, does not keep people from receiving treatment for other medical issues. It is already very difficult to find medical staff to help treat patients, and, of course other health needs still exist.

“In this clinic there is also a maternity ward, so we are organizing a separate area for patients with cholera or watery diarrhea where we will be able to provide treatment and avoid having a negative impact on the maternity needs and other medical needs that exist in the area. So, that is our biggest worry at the moment: how to ensure medical care if this outbreak continues in the future.”

What will the team do next?
“For the moment we are concentrating on treating people with cholera-like symptoms. But the next priority is to actually get out of the city and go look for patients. We will also do health promotion: teaching prevention so people will know how to not catch and spread cholera, and what to do if they have such symptoms.

“There are other organizations doing health promotion right now and we try to share information with them—such as where our patients come from, so they can go to those communities. And this information-sharing will also help us find out where we can have an impact.”