Meer tells me that the lab has been receiving fewer cases of severe diarrhea from the clinics. There are fewer cases of cholera also. The incidence of cholera seems to ebb and flow with the seasons, peaking in the rainy season. Now is the rainy reason in Haiti but, curiously, there is not a lot of rain. I arrived in Haiti two days ago and there hasn’t been any rain since my arrival. The last time it rained was a week ago. As we drove in from Port-au-Prince, I could see that the drainage ditches were dry and the rivers and streams had very little water flowing through them. Amanda, a graduate student from Johns Hopkins, went out with Meer yesterday to collect water samples and they told me that they saw the same thing: rivers and streams are drier than usual for a rainy season. Where is the rain? Maybe the unseasonable lack of rain is keeping the incidence of cholera down. Good for Haitians; not so good for Meer’s project.
One of my biggest concerns about returning to Haiti was the risk of getting Chikungunya. Before I left last month, I heard about many people I knew who had Chik or someone they knew had Chik. Sue told me that all of her kids at the C’ville orphanage had it. Ken, our former chief mechanic, got Chik just as he left Haiti. He was so sick on the flight home that he could hardly walk. I was a little worried. The epidemic is sweeping through Haiti and catching everyone. I’m wearing jeans despite the heat just to keep my legs covered and using Deet on my arms, neck, and face every day. And I’m careful to be sure my mosquito net is closed around my bed at night (against the mosquitoes that carry malaria; the mosquitoes with Chik and dengue are day biters). Today I read in Le Nouvelliste, the Haitian newspaper, that Dr Paul Adrien, Director of Epidemiology, Laboratory and Research at the Ministry of Public Health and the Population (and a collaborator on my STI surveillance project), confirmed that the number of Chik cases reported for the first week of July declined throughout the country. Maybe the efforts to eliminate mosquito breeding grounds are succeeding. Maybe the epidemic is burning out. Maybe the virus is evolving into a less virulent form and fewer victims feel sick enough to seek medical attention and, thus, are not counted. The cases are all classified by symptoms anyway since there are no diagnostic tests for the Chik virus. We just don’t know and the surveillance studies proposed by UF-EPI to study the epidemic may not be reviewed or funded before the epidemic dies out. Both the reduced cases of cholera and the declining cases of Chik fit a maxim of Amanda’s Ph.D. director, Dr. David Sacks. Basically he said that if you want to cure cholera (or insert your favorite infectious disease here), start a surveillance study. It is an exaggeration to be sure and more a reflection of our slow response to studying epidemics and how long it takes to set up these projects. However, I doubt that sexually transmitted infections will go away before my surveillance begins.
This afternoon, Meer and Amanda and I drove out to Petit-Goâve. Meer’s diarrheal disease surveillance project receives specimens from a hospital there: l’hôpital Notre-Dame de Petit-Goâve. I had been in contact with the administrative director of the Henri Gerard Degranges Foundation, which operates another clinic in Petit-Goâve. Earlier this year, a team from UCLA published a small study on STIs they carried out at the Degranges clinic last year. In addition to the STI work, I thought the clinic could be another possible source of diarrhea specimens for Meer’s project. I had planned to meet the director in March when she was in Haiti but our schedules never matched. I contacted her on my return to Haiti on Monday and asked if it was possible to visit the clinic since Meer planned to go to Petit-Goâve to visit Notre Dame Hospital. No problem. She gave me the clinic director’s cellphone number and I called him last night to set up the meeting.
This morning Makendy dropped off Khan at the airport for his return to Gainesville but traffic in Carrefour made his return to C’ville over an hour and a half later than we planned. We got on the road to Petit-Goâve and when the clinic director called to ask me where we were, I explained the reason for our delay and told him we would arrive about 3 pm. The clinic closes at 3 pm but he assured me that someone would be there to show us around. We arrived in Petit-Goâve shortly after 3 pm and were greeted by Mr. Georges, the accountant at Clinique de Henri Gerard Desgranges. I told him about the UF-EPI lab at C’ville and Meer’s project, avoiding the scientific details since I was talking to the accountant and not the medical staff. He seemed to understand what Meer was looking for in the collaboration (diarrhea stools) and then we talked numbers (he is an accountant, after all). How many patients do they see at the clinic per day? About 20-30, a lot less than a few weeks ago when they were seeing over 60 patients a day, mostly Chikungunya cases. How many cases of severe diarrhea? Not many at all. Any cholera cases? None. Is there a Cholera Treatment Center in Petit-Goâve? No, there was one but it closed down. So here, too, it sounded like cholera and Chik were on the decline. Then the surprise came from a chance remark. Do all the cases of severe cholera go to the Notre Dame Hospital? No, that hospital is closed. Stunned silence. I asked him again to be sure my French was not fooling me. Mr. Georges said that the Notre Dame Hospital in Petit-Goâve was closed. There was no money to pay the staff salaries so the 80 employees of the hospital went on strike last Tuesday. The employees are demanding 18 month back pay they claim that they have not received (see http://www.haitilibre.com/article-11561-haiti-sante-l-hopital-notre-dame-de-petit-goave-de-nouveau-paralyse-par-la-greve.html). I turned to Makendy. He shook his head; he didn’t know and Makendy said that he had picked up samples there last week. So maybe with the strike at the larger Notre Dame Hospital, the Clinique de Henri Gerard Desgranges will get the diarrhea patients and Meer can get his samples after all. It may be that our visit today was more fortuitous than any of us expected when we drove out to Petit-Goâve. It seems that I experience a lot of these chance events in Haiti. Maybe it happens more, maybe I just see the chances more readily here. In any case, I think our timing today may prove to be impeccable.
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