Haiti has had major struggles with cholera since the devastating earthquake occurred in 2010, with minimal resources at the impoverished nation’s disposal. The cholera epidemic ended in January 2019, and by January 2022, the World Health Organization (WHO) declared Haiti free from cholera. But, in September 2022, Haiti saw a resurgence of cholera. As the cholera outbreak in Haiti continues, organizations like the Pan American Health Organization (PAHO) and Partners in Health (PIH) are working tirelessly, offering not just medical aid but also education, a tool to empower and establish resilience.

Background

Haiti is an unstable country, with social and political unrest, a weak economy, and a high rate of natural disasters. In 2021, Haiti had the lowest gross national income of all countries in the Latin America and Caribbean (LAC) region, standing at just $1,420 per capita. In 2021, Haiti ranked 163 out of 191 on the UN Human Development Index. Meanwhile, in 2021, an earthquake caused $1.6 billion in damage and losses, which equated to 11% of Haiti’s GDP. And, in the same region in 2016, Hurricane Matthew caused losses and damages estimated at 13% of the country’s 2015 GDP. The recurring natural disasters are constantly battering an already impoverished country.

This instability carries to Haiti’s health care system, which has faced numerous challenges, with health care workers leaving Haiti due to low wages. For the health workers remaining in the country, high fuel prices make it challenging to travel to work.

Haiti experiences shortages of essential medicine and a lack of access to facilities due to geographical and financial barriers. According to the World Bank, Haiti is the poorest country in the LAC region and one of the poorest countries in the world. As of 2023, 59% of Haitians live below the poverty line, according to UNICEF. As of 2020, about 50% of the country’s rural population lacked access to drinkable water, and about one-third of Haitians had access to basic sanitation. These statistics mean the country’s people are extremely vulnerable to experiencing outbreaks of cholera.

Haiti had been declared cholera-free on February 4th, 2022, but in October 2022, 12 years after their battle with cholera began and after three years of no reported cases, there was a new cholera outbreak in Haiti. It is currently unclear how this new wave of cholera began, but lack of health care infrastructure, lack of clean water, and extreme poverty are the primary culprits.

The Caseload

Based on the most recently published update from the Pan American Health Organization (PAHO) in August 2023, there have been 3,696 confirmed cases, with 77% of the patients being younger than 10 years old. There are a suspected 58,230 cases in the whole of Haiti, which is almost 15 times more than the confirmed cases supply. Cholera is a disease with a high rate of survival, especially outside of the younger population, so that is likely why so many of the confirmed cases are so young- they are those who have to receive professional treatment.

Many patients have to walk long distances to access care, especially with gas prices on the island skyrocketing. As of 2017, there were seven hospital beds per 10,000 people in Haiti. They also have to walk long distances to get to clean water, with access points ever-changing. People fight over water on busier days, and bottled water is not very affordable for most as a primary water source. Unclean water that has microscopic amounts of feces of a cholera carrier is how cholera spreads, and Haitians who are unable to afford bottled water, which is a majority of the extremely impoverished country, have to struggle to find water, which is largely unclean due to lack of funding for water infrastructure or reliable plumbing within Haiti.

Taking Action

Current strategies are varied. Largely, the challenge is in strengthening health infrastructure in a country facing rapid political changes. PAHO is working to provide an oral vaccination against the disease, as well as water purification tablets. The organization is attempting to teach improved hygiene practices in hospitals.

Partners in Health (PIH) is working diligently in Haiti as well. PIH opened University Hospital of Mirebalais in 2013, which has opened the door for more Haitians to get health care certifications, and 98% of the people who graduate from residency stay to work in Haiti instead of going to work abroad as Haitians with medical training often decide to do.

PAHO is training medical staff across Haiti on water, sanitation, and hygiene (WASH) procedures, as well as evaluating communities and 14 different prisons on their WASH policies. It has been and continues to distribute supplies that will support WASH in the communities that are most harmed by the cholera outbreak in Haiti. PAHO, in collaboration with WHO, had evaluated 68 cholera treatment centers, providing training to 126 service providers, when their last report was published in August 2023. About 916 residents had received vaccinations as well.

Ultimately, the cholera outbreak in Haiti has strong links to poverty as impoverished people lack access to potable water, proper sanitation and education. The long-term solution goes beyond providing clean water to meet immediate needs. Humanitarian organizations are working to garner lasting change and build a strong, resilient health care force in Haiti. This means that even when aid organizations leave the country, Haiti’s people will have the skills, knowledge and resources to properly manage disease outbreaks.

– Ren Pratt
Photo: Flickr