Jean Pape, MD
GHESKIO Cornell University
How does one tackle the formidable challenge of providing access to clean water in Haiti? How do we go about ensuring that over 6 million people are no longer exposed to the dangers of drinking unclean water in a country plagued by extreme poverty and challenged with multiple public health priorities at the same time? What steps can be taken today to start protecting the most vulnerable until infrastructure is created in the long term? On October 17, 2010, just ten months after Haiti was hit by a formidable earthquake that left 300,000 dead, the country was affected for the first time by the most severe cholera epidemic in recent history, four times worse than the one in Peru in 1991. With only 40% of the population having access to clean water, the majority of Haitians became the easy target of cholera – as of August 1 2015, Haiti has reported 745,401 cases of acute diarrhea, 426,856 hospitalizations and 8,965 deaths.
GHESKIO Mobilizes an Integrated Approach to Prevention
Undaunted by the immensity of the task, the GHESKIO Centers decided to start acting now and developed an integrated model of prevention and care for acute diarrhea to help protect their local community. GHESKIO is the French acronym for the Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections. It is the first institution in the developing world dedicated to the fight against HIV/AIDS.
As the massive cholera epidemic exploded in October 2010 and waves of severely dehydrated patients started pouring in at the newly opened GHESKIO cholera treatment center (CTC), it became rapidly evident that providing life-saving treatment would not be sufficient. Prevention was a key component of the solution and providing access to clean water had a critical role to play in combating the epidemic.
So as GHESKIO was busy setting up the first CTC of the West department, training medical and non-medical personnel to care for the sickest patients, steps were taken in parallel to address water and sanitation issues: education and sensitization campaigns to educate the population, clean water distribution, evaluation of water vending points in the community and training of water testers to regularly evaluate the quality and treat the water being sold, distribution of chlorination tablets and jerry cans to families to store and treat drinking water to families, hiring and training of community health agents, promotion of hygiene and sanitation in the slums, lobbying for and advocating for the first ever use of oral cholera vaccine (OCV) during an epidemic and creating a chlorine factory to ensure local distribution of affordable chlorine for water purification.
The Community Chlorine Factory
The chlorine factory stands out as a wonderfully innovative solution that has had far reaching and concrete impact on the local community. With only three staff and less than 100m2 of space needed to run the operations, this factory is able to produce enough chlorine to provide potable water to a population of 100,000 persons at a minimal cost. Providing affordable chlorine to the slum communities across GHESKIO has helped rapidly decrease the incidence of diarrheal diseases, particularly in children under five. A study done by GHESKIO in 2012 showed that families who were using the jerry cans provided for storing drinking water, and using chlorine to treat it, had 80% decrease in the rate of diarrhea in children. As a result of the various interventions used by GHESKIO to fight cholera, cholera vaccination, potable water increased availability of the use of chlorine, and promotion of hygiene and sanitation, cholera has been eliminated in the vaccinated residents living the GHESKIO catchment area.
This proven model should be scaled-up nationwide and in other countries affected by cholera.