On the Road with Rain and Cholera

     Madsen, Meer and I were making another trip to Baradères. We hired Lamothe’s (Gift of Water) driver and his Nissan Patrol. The driver, Patrick, arrived in C’ville at 7:30 am Wednesday. We had breakfast and started loading up the Patrol. It already had boxes with 98,000 Aquatabs that I had ordered for the Gift of Water program in Baradères. Meer gathered up some bottles to collect water samples and also some containers for stool samples in case we find any cases of cholera in Baradères. There was still some room in the Patrol so I asked if we could fit in the blood chair (for doing blood draws) that Kathy from Operation Ukraine had found and brought for us back in March. It fit nicely. So I felt better. I would not be going up to see Sister Denise empty-handed.

     We never seem to make trips without multiple stops and this trip was no exception. First, we headed over to the Gressier clinic to look for Dr. Celestin, the Clinic Administrator. I still needed to resolve some concerns about the clinic before we could start my STI surveillance project there. Madsen had been trying to reach Dr. Celestin by phone for two days without success. Madsen walked into the clinic and came out less than a minute later. Dr. Celestin was gone. He had been transferred. There is a new person in charge. Madsen has the new person’s name and an appointment to meet with him. This change could be a good thing for my project. We can negotiate all over again and hopefully get what I need at the clinic. We’ll see after we get back from Baradères.

     Our next stop was in Léogâne at Eva’s gas station to fill up the Patrol. As with almost all vehicles in Haiti, the Patrol runs on diesel. It cost 3680 gourdes, about US$85.00, to fill the tank. Madsen and I walked over to the Western Union office and I exchanged US$100 for gourdes and I paid for the fuel. Next stop, the Digicel store. I bought a cell phone for my Study Coordinator. When we get back, I will give the phone to Youseline and load it up with gourdes. This way she can compensate the participants in our study (250 gourdes each; US$5.00) by transferring the money directly to their cell phones instead of me trying to find phone cards to hand out. Next stop, Dr. Merisier, the regional director for the Ministry of Public Health and the Population (MSPP). Madsen had already sent him a copy of my protocol and the approval from the MSPP Bioethics Committee. He just wanted to stop in and introduce me. We spent five minutes at the clinic and were on the road again heading west toward Petit Goâve.

Meer and Dr. Madsen at the Petit Goâve Cholera Treatment Center

     At the entrance to Petit Goâve we pulled into the gas station and Madsen made a phone call. We were going to visit a Cholera Treatment Center (CTC). Cholera cases are on the upswing in the Petit Goâve area and the MSPP had re-opened a CTC outside Petit Goâve. Someone was going to meet us and guide us to the center. A pickup truck arrived and we followed our guide through Petit Goâve towards Miragoâne. We turned off the National Route #2 drove down a dirt side road and then turned onto another dirt road. Five bumpy minutes later, we arrived at the Dispensaire Madeleine. Madsen greeted the clinic doctor and introduced us. Then the doctor led us down a narrow path that ran alongside the concrete clinic building. The CTC was in the back.
It was a makeshift shack made of plywood with a sheet metal roof. At the entrance there was a bucket of clean water on a table and a flat box with a mat soaked with bleach on the ground.

Poster for the campaign against cholera

     We stepped into the box and then into the CTC. There were five patients, including one child, inside. Some were lying on the cholera cots, some were sitting up on the cots. We learned that at least two people had died of cholera recently in the Petit Goâve region. Over the past few months the world watched in horror as Ebola spread through West Africa and then began to decline. Meanwhile, the rainy season came late to Haiti and with it came cholera. The MSPP had closed many CTCs over the summer because there were so few cholera cases. Now the only two CTCs in the region were the one we were visiting and the one in Gressier. Cholera is back. It had never left. The microbe is established in the aquatic environment. It was lying in wait for the heavy seasonal rains to come and mix up the waterways with nutrients that flowed down from the mountains. The bacteria grow, the people drink the contaminated water and cholera is back. Meer shook his head, sadly. He knew all along that cholera would be back. His research published earlier this year showed how the bacterium was now part of the aquatic ecosystem. And now cholera is back.

Family with child who has cholera, Petit Goâve CTC

     We stepped out of the CTC, onto the bleach-soaked mat and washed our hands before heading back to the Patrol. The clinic’s truck was parked in front of the Patrol. Madsen pointed to it. I looked over. Piled in back of the pickup were buckets and hand-held pump sprayers. Buckets for the cholera cots and sprayers for bleach to decontaminate. The MSPP was preparing the CTC in anticipation of more cholera cases. Cholera is back.

Cholera patient lying on a cholera cot, Petit Goâve CTC

Cholera patient lying on a cholera cot, Petit Goâve CTC

     We climbed into the Patrol. It was 11:30am. No more stops. We had another three hours of driving ahead of us before arriving in Baradères. I called Sister Denise and told her we would probably be in Baradères by 2:30pm. That estimate was going to be wrong, very wrong.