Haiti Cholera: the introduction of an inclusive implementation model on Water Quality, Vaccination and Education - a Comprehensive solution for Policymakers
Sidney Coupet, DO, MPH Robert Wood Johnson Foundation Clinical Scholar Department of Internal Medicine University of Michigan Doctors United For Haiti (DUFH) Founder and Executive DirectorHaiti Cholera: The introduction of an inclusive implementation model on Water Quality, Vaccination and Education. A Comprehensive solution for Policymakers.
Topics for Discussion Cholera in Proposed The Projected Haiti Model impact The steps to discovering a solution
Haiti’s Cholera EpidemicIntroduced to Haiti October, 2010 and is expected to remain.
-POOREST NATION IN THE WESTERN HEMISPHERE.-40% OF THE POPULATION RELY STRICTLY ON TRADITIONALHEALERS.-INADEQUATE SANITATION SYSTEMS AND NO RELIABLE SAFEWATER SUPPLY IN MOST PARTS OF THE COUNTRY.-ANY MAJOR STORM CAN PRODUCE SERIOUS FLOODINGAND SUBSEQUENTLY TRANSMIT RELATED INFECTIOUSDISEASES AND WATER BORNE ILLNESSES.-DIARRHEA AND INTESTINAL DISEASE DEATH RATE IS 31.97%COMPARE TO US 7.35%. Fertile Environment for Cholera
JANUARY, 12, 2010 HAITI’S DEVASTATING EARTHQUAKE-LOST OF AT LEAST 300 HEALTH CARE PROVIDERS-OVER 2 MILLION DISPLACED AND LIVING IN TENT CITIES INCLOSE QUARTERS-MASSIVE DISTRUCTION OF HEALTHCARE RELATEDINFRASTUCTURES(HOSPITALS/CLINICS/DISPENCERIES/MINISTRIES OFFICES)-MASSIVE INFLUX OF INTERNATIONAL AID A window of opportunity for Cholera
Cholera’s Impact /Interventions /Missed Opportunities Over 300,000 infected and >5,000 deaths so far. Current Interventions CTC for acute care Water chlorination Dissemination of health information through mass media Despite the above interventions Morbidity and Mortality are still rising. Controversies surrounding the Cholera Vaccination has delay its use in the country.
Cholera Vaccination?• Short stock pile of the vaccination (Dukarol/Shanchol:200,000)• Requires 2 doses or 1 dose• 80% protective for 3 years• Liquid and orally administered• Requires 2-8 degrees Celsius• General gaps – Vaccination dissemination – Limited stock pile – Shortage of healthcare workforce – Storage
The Proposed inclusiveImplementation Model. Increases the reach of all Cholera Interventions
The Best Cholera Intervention is Comprehensive Coupet/Nassiri Model: 9/2011
The Haiti Proposed Key Players Inclusive Implementation Model for Cholera Intervention. Water Screening for Cholera Vaccination Key Players Community Health workers Haitian Healthcare Providers Public health Officials Traditional healers Physician/nurse partners abroad Education Acute Care Integrated Inclusive Model: Coupet/Nassiri
The Proposed Model’s Logistical Approach – Planning • We will devise a course of action that will match using geographic locations to partner health facilities with near by traditional healers. We will also provide the traditional healers education at the sites. – Engaging • We will use volunteers who live in the communities and patients who were recently affected by cholera to identify a traditional healer in the area. We will also use a snowball effect to recruit other traditional healers. – Executing • We will have a highly trained public health official function as a liaison between the health centers and the traditional healers. – Reflecting and Evaluating • We will measure the participation rate of traditional healers and willingness of Faith Base Organizations (FBO) , Non-Governmental Organizations (NGOs) and Minister of Health (MSPP) to work with traditional healers. • We will evaluate the feasibility of traditional healers serving a role in educating, referring patients and administering vaccine. • Evaluating the outcomes of involvement of Healthcare Volunteers from abroad. Realization of the Added Value of the Inclusive Model
The Projected Impact ofthe InclusiveImplementation Model. Expanding The Reach of all Cholera Interventions
The Haiti Proposed Key Players Inclusive Implementation Model for Cholera Intervention. Water Screeningfor Cholera Vaccination IMPACT Reduced cholera Key Players Community Health workers morbidity and Haitian Healthcare Providers mortality, Public health Officials Healthier Traditional healers populations, Physician/nurse partners abroad Reduction in workforceEducation Acute Care “downtime” Model Suggested by: Coupet/Nassiri
Measured Impact of Key Players Key Players Education Vaccination Water Acute Care Screening for Cholera Community +++++ +++++ ++++ + Workers in Haiti Physician/Nurse +++++ +++++ +++ +++++ Providers in Haiti Public Health +++++ +++++ +++++ + Officials Traditional +++++ +++++ ++++ +++ Healers Physician/Nurse +++++ +++++ ++ +++++ partners abroad. Opportunity for One Health Approach
Collaboration-Everyone will be able to serve as an anchorto expanding the reach of any choleraintervention.-Capitalizing on already established trust withcommunities,-Enhance the effectiveness of any proposedcomprehensive intervention for cholera It’s about team work.
Our Integrated Academic Approach is in part a step towards the introduction of One Health Approach in Haiti.