1/8/2011

Cholera

Most of what I’ve learned about cholera comes from public service announcements on Haitian TV and radio. One entertaining TV announcement features popular comedian, Ton Ton Bicha, and hunky music star, Ti Jo from Kreyol La. On the screen we see an ailing Ti Jo explaining in graphic detail his textbook cholera symptoms to goofy Ton Ton Bicha who tells him what to do to get better. Sometimes I hear people on the street singing the jingle from it…. ‘Ti Jo pap mouri, Ti Jo pap mouri!’ (Ti Jo isn’t going to die!)

I’ve also seen many pamphlets like the one that the Diocesan development arm (CEDDISEC) circulates which explains how to keep from contracting cholera and what to do if you or someone you know becomes infected.

Thanks to these efforts by the Haitian Ministry of Health and the NGO’s, just about anyone on the street in Port au Prince seems to be able to recite the recipe for the oral rehydration serum.

The announcements however have not answered all of my questions about this scary bacterium and until yesterday, I’d been filling in the gaps with piecemeal word of mouth info. In an effort to clear up the muddy waters (in my head) I sought out legit answers.

Below are my findings.  They are not a complete resource, but just some answers to questions that might be of interest especially to foreigners traveling to Haiti.

Can one contract/spread cholera through casual contact with infected people?

Cholera is rarely spread person to person. It is spread when the feces of an infected person gets into the water people drink or the food that they are eating. The bacterium must be ingested. A scenario of person to person transmission would be a parent cleaning their infected child’s bottom and then the parent putting a soiled finger in their mouth or transferring the poo particles onto food and eating it.

(CDC. Cholera Prevention and Control. <http://www.cdc.gov/cholera/prevention.html>)

Is a prudent traveler safe from contracting cholera?

Visitors are unlikely to catch it, but are not completely safe. Visitors in Haiti generally drink clean water and use hand sanitizer religiously. That puts them at low risk. Still there are a few preventative measures that might not be completely obvious even to very prudent travelers.

1.        Wash hands thoroughly with treated water or use hand sanitizer after using the restroom and before eating then shake to dry

Some facts about using hand sanitizer:

*Hand sanitizer must contain more than 60% alcohol to kill the bacterium.

*Apply enough hand sanitizer that the entire surface area of your hands still isn’t dry 10 seconds afterwards

*Hand sanitizer doesn’t do a good job of soaking through grime, so rinse visibly dirty hands with water before applying

           2.   Use treated water for everything – drinking, ice, washing hands, preparing food, washing dishes, brushing teeth, even bathing. Treat a bucket of water with chlorine or other treatment for bathing.

3.      Only eat fully cooked food that is still hot and fresh fruits and veggies that you have washed and peeled yourself. The bacteria can flourish in food that has been contaminated after cooking and then allowed to sit at room temperature.

(Deborah Franklin. “Hand Sanitizers, Good or Bad?”. The New York Times. March 21, 2006. <http://www.nytimes.com/2006/03/21/health/21cons.html>), (CDC. Cholera Prevention and Control. <http://www.cdc.gov/cholera/prevention.html>), (The Mayo Clinic. Cholera Prevention. <http://www.mayoclinic.com/health/cholera/DS00579/DSECTION=symptoms>)

What should a visitor to Haiti have on hand?

The CDC recommends: An antibiotic to treat diarrhea, access to means of purifying water, oral rehydration salts or serum packets, hand sanitizer with 60% or more alcohol content 

(CDC. Travel Health Precaution. <http://wwwnc.cdc.gov/travel/content/travel-health-precaution/haiti-cholera.aspx>)

Is there a vaccine?

Yes, there are two: Dukoral, which is WHO approved, and ShanChol, which is not at this time. Neither are available in the United States. Dukoral is a two or three dose vaccine which reduces an individual’s risk of contracting cholera for about 2 years. The CDC doesn’t recommend the vaccine for most travelers because, “the available vaccines offer incomplete protection for a relatively short period of time.”  (CDC. Cholera General Information. < http://www.cdc.gov/cholera/general/>)

Vaccinating might not be used as a means to slow the outbreak because there is a limited amount of the vaccine stockpiled in the world and it is difficult to administer since it is a double or triple dose over a period of weeks. Also, the vaccines, when administered properly, provide up to 90% immunity to cholera – in other words, vaccinated individuals can still spread the germ.

(Donald G. McNeil Jr. “Haiti, Cholera Vaccine Pilot Program Recommended”. The New York Times December 17, 2010 <http://www.nytimes.com/2010/12/18/world/americas/18briefs-Haiti.html>) , (Richard Knox. “Cholera Vaccine Isn’t The Answer for Haiti”. NPR October 28, 2010 <http://www.npr.org/blogs/health/2010/10/28/130884642/why-the-cholera-vaccine-isn-t-the-answer-for-haiti>) 

Can one have cholera and not even know it?

Yes. About 80% of people with cholera show mild or no symptoms. Infected people without symptoms can still spread the germs just like other infected people via their stool for two weeks.  

(The Permaculture Guild. How to Prevent and Treat Cholera. <http://www.permacultureguild.us/how-to-prevent-and-treat-cholera/>). (The Mayo Clinic. Cholera Symptoms. <http://www.mayoclinic.com/health/cholera/DS00579/DSECTION=symptoms>)

Isn’t cholera just a horrible case of diarrhea and vomiting; why are so many people gravely affected by it?

Cholera continues to spread in Haiti. Some epidemiologists estimate that the outbreak could persist for three to five years. Lack of sewage treatment and access to clean water allow the germs to spread. Access to health care is limited and the onset of symptoms is rapid. People die of cholera due to extreme dehydration.  People with healthy immune systems can generally fight off the bacteria if they stay hydrated.   

What can be done to help?

Donate to organizations that are working hard with the Ministry of Health to stop the spread of cholera. Visitors can bring extra rehydration packets and hand sanitizer with more than 60% alcohol with to share. 

1/3/2011

My Christmas Eve in Haiti

A friend of mine started an organization called Voix et Actions (Voice and Actions). It’s a group of young professionals between the ages of 25 and 35 who put their heads together to improve their community. The members work for cell phone companies, banks, NGO’s, the UN, and a couple like myself work for the Episcopal Church.

Most members attended College St. Pierre, the Episcopal Church’s prestigious middle school in down town Port au Prince. College St. Pierre was very badly damaged in the earthquake and around sixty children died. Voix et Actions is a result of some former students recognizing the importance of maintaining contact with one another.

Our first big activity was going to be a Christmas gala held on the athletic field at College St. Pierre to benefit the school. Unfortunately with the political unrest after the announcement of the election results, we decided that it could be too dangerous to hold the gala.

Instead, the group turned its focus on what small things could be done during the holiday season to make it festive for people who might not have the means to celebrate. 

On Christmas Eve, the founder of the group organized an activity for the children of St. Jacques’ church in Petion Ville. We sang a few songs, did a hand washing demonstration, and then provided each with a hot meal of rice and beans and chicken.

Afterward, most of the children stayed at the church for a lock-in. All afternoon and into the night they sang and beat drums. They took a break from the drums for about an hour to listen to a group of English speakers who came together to sing Christmas Carols. By candlelight, a group of about 6 people assembled around the church’s gorgeous Steinway grand piano and remembered Christmas in our homes with every carol from ‘God Rest Ye Merry Gentlemen’ to ‘I saw Mommy Kissing Santa Clause’.

After the service, I brought out my hula hoops and joined the children in their singing, drumming, and dancing. Around midnight, several friends and I headed out to a favorite hang-out spot downtown to listen to the DJ for a couple of hours.

Outside the church, the streets were teeming with people old and young roaming the streets freely visiting friends, buying street BBQ and moonshine from gas-light lit stalls. Everyone was immaculately dressed.

During the season leading up to Christmas, I heard very few friends talking about what gifts they would purchase. Most of the dialogue surrounding Christmas was about which family members were coming in from abroad, what food would be prepared, and what plans they were making with family and friends to celebrate.

There was a bittersweet sense of remembering Christmas 2009 and also a sense of gratitude for the calm in the city which allowed people to maintain the tradition of staying out all night long on Christmas Eve.

12/9/2010

What a week this has been! THANK YOU to the excellent energetic CREDO staff who hosted a successful conference for the Diocesan clergy and laity at one of Haiti’s most beautiful resorts, Club Indigo. People arrived in Montrouis from all over Haiti on Sunday evening to a delicious dinner followed by a Eucharist offered in French by CREDO staffer, Lee Crawford.  The mood was festive as we all looked forward to the days of nourishment, reflection, and empowerment that lay ahead.

In one memorable session, Diocesan leaders were divided into groups based on region and were given 45 minutes to construct ‘something we were proud of’ made of pipe cleaners and straws.  Our group of Port au Prince-dwellers decided to build a lovely earthquake-resistant, environmentally friendly guesthouse. By the time our wobbly construct was finished we had survived several successful confrontations between us and realized had we taken time at the beginning to make a good plan, our final product would have been better. We also found that with eight of us in the group, we had many opinions to work with. This was a strength, but also meant that our construction process took longer.

I found the experience paralleled the seemingly modest pace of rebuilding here after the earthquake. Not only the many affected structures of the Diocese of Haiti, but of the country as a whole. The challenge is seizing the opportunity to rebuild everything BETTER and to do that successfully, many factors must be considered. Thus, the process is long, but I feel that taking the extra time on the front end will pay off in the end. .. as long as leadership can encourage focus.  

Speaking of leadership, most of you who will read this know that the results of the Nov. 28^th elections in Haiti were announced on Tuesday evening.  The subsequent unrest all over the country colored the remaining day of the conference.  In President of CREDO, William Craddock’s, closing remarks, he asked several poignant questions which encouraged us to think of the years ahead in flexible terms. He asked, ‘Is the future of Haiti burning tires and blockades in the streets? Is it profound loss of life after natural disasters?’ It was a great chance for all present to remember, ‘It doesn’t have to be this way!’

The conference in general freed us to imagine what can be.

This photo is of the clergy, lay leadership, and CREDO staff.... What a fine bunch of people !!!!

9/10/10

Haiti’s presidential elections are set to take place on Nov. 29th. Among the candidates are a former political prisoner and Prime Minister under Aristide, a female professor and former first lady, and a popular compa singer called ‘Sweet Micky.’ The refusal of Wyclef Jean as a candidate is all the buzz. He even composed a special song explaining why he’s not the ‘diaspora’ candidate that plays on the radio every third song. Everyone has an opinion and the general feeling that I get from people I meet is that they are not going to miss their chance to vote in this election.
Here's a link to Wyclef's new song:
http://www.youtube.com/watch?v=UMJKAP2DXSM





I made a new friend this week. His name is William and he is ten years old and I met him when he followed me to work on Monday and asked me to marry him. When I politely declined, he thought a minute before saying, ‘Madam, what if I told you I could buy you any model of Mercedes Benz you want?’



William marches along with a bouncy step and his chin raised. He’s a great security escort. If anyone on the street tries to bug me, he dismisses them with a wave or transmits the evil eye. People smile at his nerve and they also leave me alone. When he meets his buddies in the road, he shakes their hands like a rapper turned politician and asks how their families are doing. This kid is clearly leadership material.


Today we struck a deal. He’ll provide protection on my commute each morning and I’ll pay him our agreed upon amount at the end of each week. If he misses a day without a good excuse, he won’t get anything that week. For further compensation, I’ll continue teaching him words in English. At this point his vocabulary consists mostly of four letter words.






Sometimes I have a hard time understanding when people tell me their names. I’m almost always obliged to ask how the name is written. It seems that must be a universal affliction as people call me all kinds of crazy things that sound somewhat similar to Angela. Two of my favorite new names so far are ‘angina’ and ‘enema’. Who knew my name resembles so many unpleasant medical terms.

This first week in Haiti has passed faster than a turtle on a skateboard. I've been caught in a very un- stereotypically Caribbean whirlwind of bustling activity. There has been a lot of work for me to do and more than anything I think I have appreciated feeling useful.




I finally unpacked my suitcases last night. My apartment is inside the walled enclosure of St. Jacques Church in Petion Ville - a short walk from the Diocesan office. The music school, St. Trinity, now resides there. For those of you who have spent a summer in Sewanee, TN during the Summer Music Festival, you can imagine the mostly delicious cacophony of classical sounds that I enjoy every day. Another perk is that there is a piano right outside my room for me to mess around with anytime I feel the urge.



Over the course of the past week, I've slept in Les Cayes, Cange, and Port au Prince. In Les Cayes, I translated for two terrific techies, Todd and Tony, as they worked with Business and Technology Institute technician, Denis, to prepare the computer lab there for the coming semester. Learning some much needed computer skills was a positive byproduct for me. From Les Cayes, I traveled with the Partnership Program director to the Diocesan Conference on Reconstruction in Cange. Renowned economist, Kesner Pharel, spoke to the group of 20 influential leaders within the church about dreaming big and planning precisely. My job was to take minutes in English.


One of my favorite moments from the past week:

A friend of mine, Amorce Dugé, recently purchased land which he will transform into a haven for artists of all sorts. Every year he hopes to facilitate a month long festival featuring different mediums each week. The artists will stay economically in 16 bungalows arranged around a pool and a large workshop space. Dugé himself writes novels and poetry. One early morning we scooted out to his land to dream about possibilities.