Patients recuperate at a ZL cholera treatment center.

Zanmi Lasante-supported cholera treatment centers and treatment units in Port-au-Prince, the Lower Artibonite, and the Central Plateau regions are seeing a worrisome rise in cholera cases. 

Though official numbers won’t be available until next week, Dr. Maxi Raymonville, ZL’s Director of Women’s Health, reports that the organization’s hospitals and clinics experienced a significant jump in the number of people contracting cholera during the first weeks of April. At the ZL cholera treatment centers and units in Mirebalais, near the site of the original outbreak, numbers were roughly triple what they were just a few weeks ago.

In March, ZL saw a total of 5,136 patients presenting with symptoms of cholera across all 14 of its sites in Haiti. Of those patients seen, 2,459 required hospitalization for cholera.

To Dr Raymonville and his colleagues, the spike in cases comes as no surprise.

ZL knew that cases of cholera, like any waterborne illness or diarrheal disease, were likely to surge at the onset of the rainy season. While Dr Raymonville's team was prepared to treat more patients, he remains concerned that flooding will prevent people from accessing cholera treatment quickly. Since cholera often debilitates a person in less than 24 hours, it is critical that a patient be able to access medical care quickly.

The rainy season arrives as Zanmi Lasante is making a concerted effort to transition its cholera work from an emergency response posture to an integrated proactive and preventative approach in recognizing that the disease is now endemic to Haiti.

Yet, flooding at facilities in Boucan Carre and Thomonde is making it difficult to treat patients, and therefore inhibiting ZL’s ability to shift away from an emergency response mindset.

Having written one of the first cholera prevention and treatment training curricula for community health workers, Zanmi Lasante is focused on training more frontline health workers to educate their communities, identify cholera infections, and help those ill to quickly access care. In addition to education, the ZL team is working with communities to improve hygiene practices as well as access to potable water and latrines.

As Dr. Maxi notes, ZL staff are reminding communities that they must seek care quickly in order to treat the disease and protect family and friends from becoming infected. The organization’s cadre of community health workers have been educating a catchment area of 1.5 million people about the disease since the outbreak began last October.

On average, Haiti receives 452 mm (18 in) of rain between March and May—more than 40 percent of the nation’s annual rainfall. Years of deforestation and erosion have left the island’s soil so dry that it is non-absorbent in many regions. As the rains come, they cause dangerous flooding which leaves large pools of standing water—conditions ideal for waterborne diseases like cholera, or other illnesses like malaria. During last year’s floods, for example, ZL had to use UN helicopters to reach communities isolated by flooded roads and unstable bridges.

Other actions underway include evaluating the ability of cholera treatment facilities—which are housed in standalone tents—to withstand the current rainy season and upcoming hurricane season, which runs from June to September.

Understand how cholera spreads and why it disproportionately affects the poor.