Haiti: The EPFL and Tdh fighting cholera together
_From the site of the Federal Polytechnic School of Lausanne
Two laboratories of the EPFL are devoting energy to Terre des hommes. They have set up a working group to develop tools able to predict the spread of bacteria and organise health aid most effectively.
In January 2010, an earthquake of over 7.0 hit Haiti, destroyed the capital, Port-au-Prince, caused 230 thousand deaths and injured more than 300 thousand people. A state of emergency was declared. Over ten thousand NGOs hastened to the area, as well as UN Blue Berets. Humanitarian workers and peacekeepers saw to first aid: distribution of drinking water, medical treatment, clearing rubble. Aid which would be faced, nine months later, by cases of cholera. The carriers of this disease are polluted water, fruit and vegetables watered with it, and dirty hands. With no water-processing plants, all waste is dumped into the rivers. And the rivers in Haiti are strategic places where the washing is done, kids play and the water is used for drinking. One year and a half after the disaster, most people are still living amid rubble and rubbish.
A strain of bacteria unknown in South America
No cases of cholera had been registered in the country in the past 100 years, and people were not prepared for it. Studies have shown that the bacteria is identical to ones found in Asia and which could have infected UN soldiers from Nepal. Prior to their arrival in Haiti it is unlikely that they had time to undergo tests, and as the strain appeared only after they moved in, downstream from their camp, it is possible that it was transmitted through their waste water. “If the disease is untreated, it develops into terrible diarrhoea”, explains Melanie Blokesch, a professor at the EPFL Molecular microbiology laboratory, and a specialist for the evolution of the cholera bacteria, “20 litres of fluid per day can be lost, and children succumb within a few hours”. Saline infusions can prevent fatal dehydration, and it is essential to be able to predict the short-term movement of the bacteria so as to warn health organisations and to protect the people.
When the Environment meets Life Sciences
Andrea Rinaldo, in his Laboratory for ecohydrology at the EPFL, does research on the role of fluvial networks, veritable ecological passages, in the spread of water-borne diseases. Soon after the appearance of cholera at the end of 2010, he published a spatial model to allow prediction of the distribution of the pathogenic bacteria, in places, times and by human mobility in Haiti. “We have to improve the model and understand why it does not always correspond to reality, and why inexplicable epidemic peaks are seen. For this reason we have decided to go on-site and check out the area ourselves.” The group of researchers is composed of microbiologist Melanie Blokesch, hydrologist Andrea Rinaldo, and Silvan Vesenbeckh, an epidemiologist from the Harvard Medical School.
The parameters change when you are on the spot
Since they arrived, the researchers have gone from one surprise to another; they discovered that antibiotics are distributed on a wide scale, i.e. as prophylactics. With no clear directives, some NGOs just do what they think is right, which can be quite the opposite of the WHO recommendations, and falsifies spatial representation of the problem.
The researchers ascertained that the majority of the population has no access to toilets and relieve themselves anywhere outdoors. In the rainy season, rainwater transports faecal bacteria to the rivers and pollutes them, increasing the number of people exposed to contaminated water. The rain has other unexpected consequences: “It washes away the posters on prevention and so people, not seeing them any longer, think the epidemic has been curbed and don’t bother any more with precautionary measures”, deplores Melanie Blokesch. This explains the fresh upsurge of the epidemic at this time of the year.
The EPFL mission planned meetings with various humanitarian organisations such as Médecins Sans Frontières, Terre des hommes and the WHO, so as to take into account all the elements present, and this was accomplished. Soon a new tool will be made available to the organisations so that they can set up healthcare logistics fast. Andrea Rinaldo is certain that the epidemiology of the future will be based on modelling.
What Terre des hommes does in Haiti
Working in Haiti for the past 20 years, Terre des hommes has developed help for the health and nutrition of children and mothers. Following the earthquake in January, 2010, Tdh gave access to drinking water, built latrines and showers, and cleaned up the worst-hit areas. To ensure long-lasting work, the communities were fully implicated and given training courses to learn how to renovate, sink, and maintain wells and hand-pumps. Since the beginning of the cholera epidemic, Tdh has intensified its meetings for hygiene promotion, including advice on prevention and strict hygienic measures with which to tackle the epidemic. Tdh’s teams work on epidemic prevention in the paediatric hospital unit in Les Cayes, in centres for cholera treatment and also in 44 residential centres for children (day-nurseries, orphanages). Six mobile teams, composed of specialists in health and hygiene, also work with the sick, ensure greater awareness in the communities, chlorinate water points and disinfect areas of infection (toilets, showers, beds, kitchens, floors).
“Further information on Terre des hommes’ work in Haiti”:/en/countries/haiti