“Haitians know that the earthquake has not, thus far at least, revealed a hoped-for silver lining; reconstruction remains stalled,” writes Dr. Louise Ivers and her colleagues in Haiti. “But there are hundreds of humanitarian groups that could be enjoined to participate in regional efforts to integrate cholera prevention and care. We can all do more to strengthen Haiti’s public health system.”

On December 10, Partners In Health and Zanmi Lasante, our sister organization in Haiti, published articles in two prominent medical journals on the ongoing cholera crisis.

In “Responding to Cholera in Post-Earthquake Haiti,” in The New England Journal of Medicine, the conditions and circumstances that precipitated the current epidemic are outlined. The authors of “Five complementary interventions to slow cholera: Haiti” in The Lancet, summarize the actions that NGOs and governmental organizations can still take to limit the spread of the disease, and save thousands of lives.

Since its inception, Partners In Health – in partnership with Harvard Medical School, Brigham and Women’s Hospital, and the Harvard School of Public Health – has broadly disseminated our experiences in the field, in the hope of better informing future medical research and improving our own work within resource-poor communities. Because it appears that hundreds of thousands of Haitians will become ill from cholera in 2011, we must refine and strengthen what we know about treatment and prevention as quickly as possible.

In The New England Journal of Medicine article, Dr. David Walton, PIH’s Deputy Chief of Mission in Haiti, and Louise Ivers, PIH’s Chief of Mission in Haiti trace some of the events that led to the outbreak. They focus on why the outbreak began in the Central Plateau, and how the disease – not found in Haiti for roughly five decades – was reintroduced into the country.

Walton and Ivers also correctly argue that the origins of this crisis took root well before the January earthquake. “The cholera outbreak took most people by surprise. Unexpectedly, it was centered in rural Haiti not in the displaced-person camps that are situated mainly in the greater Port-au-Prince area,” they write. “But history would suggest that an epidemic outbreak of waterborne disease was just waiting to strike rural Haiti.” For example, Walton and Ivers assert, it is “well known that Haiti has the worst water security in the hemisphere. In 2002, it ranked 147 out of 147 countries surveyed in the Water Poverty Index.”

Read The New England Journal of Medicine piece in its entirety.

In The Lancet article, Louise Ivers, PIH cofounder Paul Farmer, and PIH physicians Charles-Patrick Almazor and Fernet Léandre maintain that cholera efforts in Haiti “should be focused on improving access to clean drinking water through public works projects.”

The group of physicians puts forth five steps essential to slowing the spread of cholera in Haiti: 

 1. Identify and treat everyone suffering from cholera.

 2. Make oral cholera vaccines available in Haiti.

 3. Prevent cholera by remedying Haiti’s water insecurity and improving sanitation.

 4. Strengthen Haiti’s health system.

 5. Harmonize global health policies in Haiti, while also raising the bar on our goals.

Since late October, 80,860 cases of the illness have been recorded. 36,207 people have been hospitalized, and roughly 2,000 people have died from cholera. The World Health Organization estimates that up to 400,000 Haitians may become infected in the coming year.

“We must move swiftly, aggressively, and together: marshalling not only the tools needed to slow the epidemic in Haiti and its neighborhood, but also the political will of global health authorities and funders and large-scale implementers… n this dire emergency, we can accept nothing less than complementary prevention and care,” they write.

Read the full article from The Lancet.