Reportaje sobre la labor y experiencias del Equipo de Médicos Cubanos y las Asociaciones Internacionales en Haití

Gorry CMA “Haiti One Year Later: Cuban Medical Team Draws on Experience and Partnerships” MEDICC Review, January 2011, Vol 13, No 1

 Un año después del devastador terremoto en Haití,  MEDICC Review publica  un reportaje especial sobre la labor de los 14 mil  profesionales de la salud cubanos, haitianos e internacionales que laboran conjuntamente para enfrentar las secuelas del desastre y contener la actual epidemia del cólera en Haití.

 “Haiti One Year Later: Cuban Medical Team Draws on Experience and Partnerships”

 Early a year ago on a day like today—as people scrabbled for some charcoal to cook the evening meal, fetched their children from school, and sewed costumes for carnival—the ground began to shift. Buildings folded and houses crumbled. In the time it takes to read this paragraph, one of the most devastating earthquakes recorded in the hemisphere changed the Haitian landscape forever. Twelve months on, quake sur-vivors struggle to live, study, work, and worship within the parameters of this new landscape. They also struggle to stay healthy. “It’s important to be vigilant,” Dr Jorge Pérez, deputy director of Cuba’s Tropical Medicine Institute, told

 MEDICC Reviewin Port-au-Prince last March after assessing the post-quake health situation. “The epidemiological picture is going to get much more complicated.”[1] On October 21, nine months after the earth-quake that killed 250,000 and left over one million homeless, his prediction was borne out when the first cases of cholera were confirmed by the National Public Health Laboratory in Port-au-Prince.[2] By November 19, the outbreak had spread to all 10 departments across the country. As of December 26, a total of 148,787 cases had been reported with 3,333 deaths, for a case fatality rate of 2.2%.[3] Cholera—a disease not seen in this Caribbean country for a  century—“is now entrenched in Haiti and conditions on the ground are such that we should expect many more cases,” reports Dr John Andrus, Deputy Director of the Pan American Health Organization (PAHO).[4] Indeed, Haiti is now experiencing a full-blown cholera epidemic caused by Vibrio cholerae, challenging health care providers to develop strategies and response mechanisms to effectively contain the disease and protect the healthy population. Among those at the forefront of these efforts are the Cuban medical team and its international partners.

 Cholera Emerges

Some of the first suspected cases occurred in Mirebalais, in Haiti’s Centre department. Dr Adac Mendoza and Dr Yobana Car-menza, Nicaraguan and Colombian members, respectively, of the Cuban-led medical team, are posted at the Mirebalais Compre-hensive Health Center, where an outbreak was identified on October 15. Both these doctors are among the graduates of Havana’s

Latin American Medical School (ELAM, its Spanish acronym) who joined Cuban health professionals in disaster relief efforts shortly after the quake.

Dr Mendoza told MEDICC Review that they became concerned when they saw a sudden rise in acute diarrhea patients of all ages presenting at the hospital. Within days, “we were thrust into a frightening scenario, as more patients arrived in different stages of dehydration, with frequent, watery diarrhea and vomiting.

 Some died of spontaneous cardiac arrest,” said Dr Mendoza. “We began to suspect cholera.”

“There was a lot of confusion and fear during those first days. Things were disorganized and lack of coordination also created a bottle-neck,” Dr Mendoza explained. Scarcity of antibiotics, combined with the highly unsanitary living conditions that continue to plague Haiti, and the fact that cholera had not been seen in the country for generations, also complicated adoption of effective strategies.

 Coordinating Response, Maintaining Services

Once cholera was confirmed, the Cuban medical team, which is a member of the Ministry of Health-PAHO/WHO Health Cluster coordinating the epidemic response, adopted international cholera treatment protocols and strict biosafety guidelines for all personnel, among other measures. This response also included establishing separate Cholera Treatment Centers (CTCs), smaller Cholera Treatment Units (CTUs) and Oral Rehydration Posts (ORPs), as well as relocation of resources medicine, tents, equipment, and health staff  to those areas experiencing outbreaks. Health prevention messages in Creole were drafted and distributed, using every avenue, from sending cellular text messages to preaching prevention from church pulpits.[5]

 Reinforcements from the Henry Reeve Emergency Medical Contingent arrived from Cuba in early December. Since 2005, the Contingent’s specialists in disaster medicine and epidemics have been dispatched following disasters in countries such as Pakistan, China, Guatemala, Chile, and most recently Haiti. Within 24 hours of the January 2010 earthquake, the first Henry Reeve detachment arrived in Port-au-Prince to supplement the Cuban teams already working in Haitian public health facilities since 1998 under bilateral government agreements. When the post-disaster emergency phase officially ended last spring, the Cuban-led team of over 1000 health professionals stayed to contribute to rebuilding Haiti’s health system, including stafing of 30 comprehensive health centers, another 30 community referral hospitals and 30 rehabilitation centers.

Last October’s arrival of fresh Henry Reeve detachments—including the Cuban specialists and doctors from 22 countries trained at ELAM—was important for several reasons. First, these health professionals are trained expressly for post-disaster contexts, to work in areas such as vector control, case management, and epidemiological surveillance.

Second, their incorporation increased the feasibility of maintaining cholera treatment centers separate from standard health care facilities—a strategy key to preventing transmission and maintaining hygiene and sanitary controls while continuing other services. “These reinforcements mean the Cuban doctors and other team members staffing community hospitals can continue their work uninterrupted,” explains Dr Yiliam Jiménez, Director of Cuba’s International Medical Cooperation. “So even though we’re in the throes of an epidemic, these communities still have other health services they can count on.

 continued……….

http://www.medicc.org/mediccreview/articles/haiti-one-year-later.pdf