Around the capital city of Port-au-Prince and in the Region des Palmes, Oxfam has been distributing hygiene and cholera kits to people in need, while continuing to provide information on how to prevent the spread of the disease. In Artibonite, a rural region to the north that was hit hard by cholera when the first outbreak occurred, Oxfam is stepping up its prevention activities. It’s providing equipment to cholera treatment centers, distributing cholera kits to hundreds of families, and collaborating closely with the local authorities.
“Unfortunately, cholera will likely, at a minimum, be endemic in Haiti for years to come,” said Thomas Mahin, a water quality adviser to Oxfam America. “The history of cholera cycles in other countries is that when the outbreak goes from an epidemic to an endemic situation, the number of cases decreases significantly but the percent of cases that are children less than 5 years old goes up. So, while the number of cases will decline eventually, the most vulnerable populations—infants, pregnant women, etc.—will still be at significant risk. So, the total number of cases only tells part of the story.”
The rain Sandy dumped isn’t only affecting the potential for a cholera outbreak. In some areas of the country, rainfall was equivalent to about 50 percent of the yearly precipitation and destroyed houses, bridges, schools, and roads.
In the South-East region, Oxfam is working with local partners to evaluate damage to agricultural areas: Sandy was the third recent weather event to hit the region following, first, a drought and then tropical storm Isaac. The cumulative effects of these crises are devastating to small farmers. Oxfam has launched cash-for-work initiatives for more than 1,000 families. The income from that work can help people meet their basic needs.
]]>Oxfam is gearing up to respond to the flooding and potential for disease outbreaks.
“We are mobilizing all local organizations trained in cholera prevention to prepare a large campaign in the coming days,” said Oxfam’s Amelie Gauthier. “Oxfam is supporting local authorities—the Civil Protection Agency and the National Direction for Water and Sanitation in various localities in the Region des Palmes—providing them with transport, logistics and equipment for now. We are preparing hygiene kits, cholera prevention kits for distribution for some temporary shelters.”
Oxfam is launching an assessment in the department of Nippes—much of it affected by the heavy rain. At least two other departments have also been hit badly by the storm: Grande Anse and South. As of Friday, the country remained under a state of alert across all of its 10 departments.
“In one area in Croix-des-Bouquets (near the capital of Port-au-Prince), we spoke to several families who now live with 160 families—more than 500 people in a fire station,” said Gauthier. “There are pregnant women and young children as part of that one shelter.” She added that many homes have been flooded and families need basic relief items such as plastic sheeting and hygiene kits.
A lack of access to drinkable water and safe sanitation in some urban and rural areas is also cause for worry. Oxfam is monitoring some of those areas closely.
“We’re also concerned at initial reports of destruction of agricultural crops caused by Hurricane Sandy in the south,” Gauthier said. “The south of Haiti is already food insecure because of the drought and impacts of tropical storm Isaac. We’re following the situation closely as this will affect thousands of farmers for the planting season as well as school nutrition programs.”
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]]>Oxfam's Country Director, Andrew Pugh, said: "The worst hit areas are in the east and southeast of the country, but we're recording damage across the board. Isaac didn't deliver the devastating body blow we expected on Friday, but we're still seeing widespread suffering for it's poorest people."
The picture emerging from Oxfam's emergency team assessment is a long list of minor impacts throughout the country that add up to giant setbacks for its most vulnerable citizens.
Oxfam Communications Officer Stephania Musset, said: "For thousands of families, Isaac is still a horrible ordeal. I saw busloads of children without parents still arriving at shelters, and heard from a woman who lost her child as they ran terrified from their flooded home in the middle of the night."
The international agency continues to plan needs assessments in different parts of the country to tailor its response to needs, and ensure it is supporting government-led efforts. Oxfam is also planning a comprehensive cholera prevention push in several areas to reduce the risk of outbreaks such as those that have plagued the country since the earthquake in 2010.
Oxfam Program Director, Yolette Etienne, said, "We're worried that people without clean water are drawing from contaminated rivers. We're also seeing people staying in homes with waist-high water. If steps aren't taken now—including clean water, latrines, and health promotion—the impact of this storm could prove deadly."
Many of those worse affected by the storm are among the 400,000 still living in tent camps, two and a half years after the earthquake that leveled Haiti's capital.
Oxfam Program Director, Maurepa Jeudy, said: "If you're living in a tent, it only takes a puff of wind to blow your house down. Many people who already had little once again lost all. Now they need basics such as soap, toothbrushes, sheets, and blankets, but what they really want is a lasting solution in place of more flimsy tents. This storm is a chilling reminder that Haiti's recovery has a long way to go."
Oxfam is supporting a citizen's watch group that is monitoring Haiti's reconstruction effort and calling for urgent solutions for the 390,000 people still exposed to storms like Isaac that regularly visit Haiti.
]]>Initial assessments of the aftermath of the storm, which cleared the island’s landmass in the early hours of Saturday morning (25th August), suggest the damage has not been as great as was feared.
There have been media reports of four deaths, but there is no evidence at the moment of major damage to infrastructure or significant casualties.
Camps in the capital Port-au-Prince, such as Jean Marie Vincent, have been flooded, as well as towns in the south of the island, including Les Cayes, Jacmel and Nippes. There are reports of electric pylons collapsing and power outages and some disruption on the roads.
However, with exceptionally heavy rainfall forecast in the wake of the storm and with nearly 400,000 Haitians still living in refugee camps after the massive earthquake that devastated Port-au-Prince in 2010, people remain highly vulnerable to the threat of flooding, landslides and water borne diseases, especially cholera.
Oxfam emergency teams are now heading out to the affected areas of the island as soon as possible, allowing workers to carry out more in-depth assessments and to provide aid to those who need it in the form of clean water, hygiene kits and public information about sanitation.
Jane Cocking, Oxfam’s Humanitarian Director, said: “The storm may have passed but living conditions in Haiti remain so challenging for so much of the population that it’s far too early to say the threat is over. People in Haiti have so little that they are incredibly vulnerable to the risks posed by flooding and disease. They remain in desperate need of our help.”
The aid agency is accepting donations to help support its emergency work in Haiti, which is often cited as the poorest country in the western hemisphere with four in five of the population living on less than $2 a day.
]]>Estimable lives in a very small earth-walled home near a drainage channel running along a dirt road. The land around her is almost all mud and the road is under a foot of water in places. Floods plague her village, called Lameau, in the community of Grande-Saline in Haiti’s Artibonite River valley.
This is one of Haiti’s most productive agricultural areas, and over the years, the government and international donors have built a network of canals and channels, to divert water to dry areas, and drain out the wet ones. Small villages line these channels. Just after the harvest, many are drying their rice crop on tarps on the side of the road, near their small homes, some of which are quaint wooden houses that resemble gingerbread cottages. Others are more modest earth-walled dwellings. Children play and swim in the channels, laughing and splashing in the sun.
It looks idyllic but the Artibonite River valley can be a tough place to live, Estimable says. “When there’s too much water in our houses, in our fields, we get upset stomachs. It’s very hard to live here with so much water.” The lack of clean water in 2010 after one particularly rainy period coincided with a cholera outbreak which killed 300 people in this area, according to local officials.
Grande-Saline’s mayor, Erole Romeus, drew up a plan to clear out the mud and vegetation choking six kilometers (3.75 miles) of the secondary channels like the one near Estimable’s house. He’s also hired heavy equipment to widen them to handle more water flow. The project is employing two 132-member work teams in a cash-for-work program that provides much needed wages of about five dollars a day for 12 days. The project prioritizes hiring people living near the channels. About 2,000 people in 400 households live in this area and will benefit from better flood control.
Sansion Morisette is one of the workers; she has just spent the morning raking weeds out of the narrow channel running along the road next to Estimable’s house. “It’s about time we started this work,” she says. “I’m out on the street now because water destroyed my house in Rossignol. Take a look around you, we’re lucky if we can get two bags of rice out of our harvest sometimes, the water just eats everything we grow.”
Mayor Romeus says the project in Grande-Saline should take the community a long way towards reducing flooding, especially during the annual hurricane season. “Every time it rains, we can have 200 to 300 small houses destroyed,” he says standing on a flooded road next to the drainage channel, where scores of workers in white t-shirts are clearing away plants and other debris.
“We started talking about rehabilitating these channels as a means to deliver a durable solution to the people here,” Romeus says. “We came to Oxfam America because it is an organization that is interested in helping vulnerable people reduce the risks of disasters.
“Since we cleared all this out, people will probably have an opportunity to harvest. But if we did not, in another week we would have been in danger: the people, crops, and animals.”
Oxfam is devoting $20,000 for this project, which is covering about half the costs and supports the cash-for-work component, wages for heavy equipment operators, and fuel. It’s part of a larger program to reduce vulnerability to disasters in the countryside, and make it easier for people to make a living in farming, an alternative to the overcrowded conditions in Port-au-Prince.
Sancion Morisette is optimistic that the newly rehabilitated channels will help them. “Now I know that when it rains, the water will flow in the channel and go directly to the sea.”
]]>“My friends,” comes the voice from the radio, “take your chairs to sit down and have some discussion about cholera now on your favorite show, ‘Some information about cholera.’”
If it is hard to imagine a show about a deadly disease as your favorite, that may be because you don’t live in rural Haiti. Here, among the beautiful mountains and broad rivers, people live with a frightening reality: it’s easy to catch cholera, and reaching the nearest clinic may take more time than you have.
Without treatment, cholera can be fatal within hours. But in rural Nippes province, what serves as a road may be the bed of a river that after heavy rains becomes a torrent. Or a footpath over steep mountains, where the rocks are sometimes covered in mud so slick that only the most sure-footed can navigate them. Where swift access to medical care is out of the question, cholera prevention takes on special urgency.
“There are some localities where we have to walk three to four hours to reach people. We use horses to go there,” says Jean Bassette, the Oxfam public health officer who hosts the show. “We can’t travel to remote areas every week, but with the radio program we can reach them easily.”
“Ti koze sou kolera,” as the show is called in Creole, invites listeners to call in. The discussions cover whatever cholera issues people want to talk about but usually focus on prevention and emergency treatment.
“If we don’t have oral rehydration salts—or sugar and salt to prepare them—what can we do?” asks one caller.
Stephanie Lormil, an Oxfam public health promoter who sometimes joins the show, explains that coconut water can be a stopgap solution, hydrating the person well enough to make the trip to the hospital.
Sensitive topics like social stigma enter in, as well.
“Treat people who have cholera with respect,” advises Bassette. “Do not humiliate them. People who have the disease need to be able to tell that to the community, and the community needs to support them by preparing oral rehydration salts and helping them get to the hospital. If people with cholera keep the information to themselves, there is risk to the whole community.”
Feedback on the show has been overwhelmingly positive. Local leaders in communities throughout the broadcast area often call in with thanks and congratulations, and people on the street have kind words for the show.
“When we first heard about cholera, we were scared,” says Jose Mira of Petite Rivière de Nippes, who cited the radio show as one of Oxfam’s successful public health efforts. “We didn’t want to live next to people who had cholera. But Oxfam helped us understand the phenomenon of cholera and gave us training. After that, it became easier. We are not scared of cholera anymore, because we know how to protect ourselves.”
Read more about Oxfam's cholera program in rural Nippes.
Donate now to Oxfam's fund for Haiti relief and recovery.
]]>This, she explains, is the result of education.
Every month in the camps near El Fasher town, a team of health workers—elected by their community and trained by Oxfam—fans out to bring messages about health and hygiene to thousands of residents. The workers go house to house, teaching newcomers about disease vectors, hand washing, and the use of latrines, and they organize community-wide campaigns to clean everything from streets to latrines to household water cans.
You might think people would resent unsolicited advice about their personal habits, but the health workers generally get a warm welcome. Women, who have the primary responsibility for the care of children and homes, are happy to receive this information, say the workers. And for the most part they take the advice.
"If they don’t want to accept what we are saying, we don't go harsh on them," says health worker Halima Nasur "We just communicate the information peacefully." But the cost of not heeding hygiene messages could be outbreaks of deadly disease, so the health workers sometimes ask community leaders to intervene. "They nicely teach a woman the importance of our work to her family. Then she listens."
For the health workers, their job is a labor of love. "I believe that all the people in the camp are my sisters and brothers," says Nasur. "We are never going to let our people down."
When it came to guarding the health of her family and community, Gado needed no coaxing. "From the public health women, I learned to cover food to keep away flies because they transmit diseases. I also learned about keeping things clean—our jerry cans, kitchen utensils, latrines, and my children's hands," she says. "Previously, my children didn’t wash their hands before they ate. They were often weak and not healthy. Now, they wash their hands before eating. They don't suffer from diarrhea, and if they happen to get sick, it isn't something serious."
Once learned, it is hard to forget the life-and-death importance of good hygiene practices, and according to Gado, the work of Oxfam and the community health workers is likely to have a lasting impact. "I learned these values, and I'm going to apply them throughout my life," she says. "I would like to thank all of the people who have supported us," says Gado, "and I wish them good health."
]]>In the midst of disasters where so many people have lost so much, why does Oxfam make providing soap such a high priority?
First and foremost, it’s because washing hands with soap is such an effective way to prevent the spread of diarrheal disease–which, under the difficult conditions of camp life, can be debilitating and even fatal.
But in emergencies, people have the right not only to health and safety but also to dignity. Soap enables a family to bathe and to wear clean clothes–simple acts with the power to restore a measure of well-being.
In the Pakistan flood emergency, Oxfam has distributed hygiene materials to more than half a million people. They include towels, water-purification tablets, sanitary pads, water buckets, and–no surprise–soap.
]]>“The destruction across the capital was stunning, and the sight of countless camps crowded with families gave me a powerful sense of how devastating this earthquake has been for people,” says Oxfam writer Coco McCabe, who recently returned to Boston from Haiti.
The camps are spontaneous, makeshift neighborhoods, marked out by plastic tarps, cardboard, and bed sheets strung between whatever’s there. Posts to hang materials on are in short supply, so people are scavenging wood from the wreckage of buildings.
“I saw one man with a flat, wide board, working hard with a small hand saw to cut the board into narrower pieces that could serve as poles for sheets, plastic, scraps of clothing—anything that might offer the semblance of a wall or roof to give families privacy,” says McCabe.
Plastic sheeting strung from poles may seem like a minimal shelter solution, and it is. But at this moment in the emergency, it’s something that works. Colored tarps keep off the sun and rain and, unlike tents, can be made to fit whatever space and terrain is available – or whatever other purpose they’re needed for on a given day.
Over the next two months, Oxfam aims to boost the supply of sturdy plastic sheeting, providing enough for at least 4,000 families (20,000 people) – a project that includes a cash-for-work component: we are employing local people to cut giant rolls of the material down to size. Families will get two pieces, each six meters by four meters, along with two 10-meter lengths of rope.
Meanwhile, we’re making plans to assemble and distribute home-repair kits to help those whose houses need patching up, not rebuilding.
But when it comes to figuring out if what’s left of your house is a danger to your family, no one should have to rely on guesswork. Oxfam will assemble a team of structural engineers to survey the damage to homes in Haiti and share their knowledge and suggestions with local residents, builders, and officials.
How long will it take for survivors of the quake to make their way from camp sites to temporary houses to real, permanent homes? For many, it will be years. But if donors continue to support the aid effort generously, Haitians will get the support they need every step of the way.
“Building back all that was lost in just a few seconds,” says McCabe, “is going to require a sustained commitment from us all.”
I flew into Mogadishu in a plane full with nine tons of Oxfam aid. We took blankets, mosquito nets, medical supplies, and plastic sheets for families to build temporary shelters. We also took 3,500 buckets: Many of the families who have fled the fighting have lost everything they had, so they can use the buckets to carry clean water and store milk for their children.
At Mogadishu airport, I was met by some of our local Somali partners who quickly unloaded the aid for distribution. We carry out all of our work in the country through partners like them.
People are still fleeing the capital. Every day more buses, vans, and donkey carts carry families out of the city along a road called the Afgooye corridor. In the past few weeks, tens of thousands of people have fled down this road to escape the violence. They are settling in camps nearby, where about 400,000 people have taken refuge in the past two years.
The living conditions in the camps in Afgooye are some of the worst I have ever seen. Families are sheltering in tiny huts, pieced together from plastic bags and sticks. When the rains come, the huts are washed away. Oxfam is about to provide 10,000 new shelters, which will improve the lives of about 70,000 people.
The most urgent need is for shelter, but people also desperately need clean water, food, and medicine. The fighting has had an enormous impact on children's health. One doctor told me that there is so much gunpowder in the air in Mogadishu at the moment that it is making children sick.
When people leave the city and arrive in camps—which are so basic and overcrowded—diseases can quickly spread, and there are few health services. I saw young children lying on the floor of the shelters, too ill to move. Many children are suffering from diarrhea and cholera. Oxfam has helped set up an oral rehydration treatment center where mothers can bring their children for help. Oxfam has also distributed mosquito nets to mothers to help them protect their children from the spread of malaria.
To help address the critical need for water, Oxfam recently expanded its water system—which features large, circular holding tanks—to reach an additional 78,000 people. In total, we now provide water to more than 200,000 people in Afgooye—and we hope to increase the supply in the coming months. Despite these efforts, the need for water remains huge. People line up for hours to get clean water.
But it was the terrible condition of people's shelters that struck me most.
"Our biggest problem is shelter," Halima Abdi, a mother of six children, told me. "If people see this house and the conditions that we live in they will be shocked. It is raining heavily during the nights. Without shelter it is a disaster for us. My children are sick and I'm worried what will happen to them. They don't have enough water or food either.'"
]]>My gift, according my father, is that while most people look at a 15-hour flight as torture, I look at is a time to get some rest. And he is right. My flight went by in a flash. I got some reading done, some work done, and slept the rest of the way curled up in my seat with my neck pillow and noise-cancelling earphones (best birthday gift ever).
My first hours in Zimbabwe were filled with contradiction. As I walked out of the airport in Harare I was greeted by clean, cool evening air. I was then welcomed by Oxfam's humanitarian program coordinator, Ransam, with a hug and a joke. But as we drove to my hotel the empty streets were shocking. It was only 10 pm, but there were almost no other cars on the road and very few people walking. We pulled into the hotel and as we walked up to reception the crickets were singing. I could tell, even in the dark, how beautiful the landscape was. But as a sign of the times in Zimbabwe, when I checked in I learned the hotel wanted me to pay cash—in advance—for my room and it preferred US dollars or Euros.
After checking in, I met up with Lyndsay, Oxfam's public figures liaison. She worked to put this trip together and I could tell she wanted it to go well. She has a lot of respect for Emile after their trip to the Congo last year. He gets it, she said, and really wants to learn. As for me, I couldn't wait to meet him and made her knock on his door at 10 p.m. to introduce us. He was tired but cheerful and very excited about the trip. We kept the meeting short: tomorrow would be the car ride to the rural area and we could get acquainted then.
I am always so tired at the end of the day in Mudzi, a region in the northeast part of the country where Oxfam has been working on the cholera outbreak. After a two-hour car ride from Harare we arrived at the Pumpkin Hotel—the only hotel in this region. We settled in (Emile got the suite with the waterbed, and I got the one next door) and had some lunch: Eggs and sadza—a finely ground cornmeal boiled in water.
After lunch, we headed out to look at a bore hole—a narrow well drilled deep into the ground. Mudzi has hundreds of them. They're the source of drinking water for many people in this rural region. This one was a half-hour-drive away on a bumpy, dry road—and when we arrived, we found hundreds of community members waiting for us.
Sitting in two large groups, they had prepared a speech and gifts: beautiful hand-crafted baskets and several large bags of fresh peanuts tied in large burlap bags with "product of USA" stamped on their sides. These bags had been recycled from earlier food distributions. The villagers wanted to show their gratitude for the work Oxfam and our local partner, Single Parents Widow(er)s Support Network, or SPWSN, had done together: teaching communities about hygiene , providing them with basic goods like soap, and repairing their bore holes.
Emile confessed to me that he thought the word was "boar" hole. And why not? if you were not a water engineer or public health person or someone dependent on these holes for water, how would you know what they were? It made me realize how little the developed world knows or understands about those who still fetch water by hand and don't have access to flushing toilets—or even pit latrines.
Back at the meeting, Emile addressed the village, thanking them for their hospitality and acknowledging their strength as a people and as a community. He was nervous and I could tell he had really thought through what he wanted to tell his hosts.
That is why this trip is so important: To get the word out. Yes, the number of cases of cholera might be less each week, but what about next year? How do we stop an outbreak from happening again? This year in this village this outbreak left 25 orphans. This is a staggering number of children who have lost their stability—all because they and their families could not access clean water.
As we drove back to the Pumpkin Hotel, I thought again, with amazement, about how so much devastation can happen in such a beautiful setting, and how the people can keep going with such optimism and positive attitudes. I realized it had been an important day for Emile, too: He was beginning to understand the context of people's lives, how they cope, and the importance of supporting them when their options run out.
We spent another long and dusty day in the field. Today we watched as nearly 2,000 people gathered to learn about cholera. They sang, laughed, and watched plays all about a deadly bacterial disease that can kill a person in a matter of days with diarrhea and vomiting. We listened to health promoters from Oxfam and SPWSN as they talked and sang about feces, and watched as they faked illness and dying—all to teach the audience about cholera.
Emile was amazed at the teams' drama and acting capabilities and at the community's ability to laugh about something so devastating. My favorite part was the singing—so lyrical and powerful. I found myself singing along (not nearly as well, of course) and envious that they could make such beautiful music with nothing but their voices.
We spent the second half of the afternoon driving to a cholera treatment center. The number of cases had finally started to wane but it was hard to know if it was just because the rains had stopped or if all our hard work was paying off. I am sure it was a combination of both—but we will know for sure next year when the rains come again. That is why we are going to continue our work after the outbreak is over: We'll introduce clean water at the level of the household using sand filters. We are going to try and break the cycle of yearly diarrheal outbreaks—lofty goal, but worth shooting for.
The day started out with a 9 a.m. meeting at the local hospital and a report on new cases. Yesterday, the cholera early warning surveillance system Oxfam put in place with SPWSN detected new cases. For the past several weeks there were only sporadic cases, but yesterday, following a funeral the day before , 19 cases were detected. It was amazing to be there and see our early warning system working—and to learn about the response. All 19 patients were brought to the health center and the response featured bore hole repairs, the delivery of supplies to the health center (including a salt and sugar solution for oral rehydration, disinfectant, tents, and beds) and the launch of a public health education campaign for the affected community. Amazing! By getting the patients to the health center so fast the hope was to avoid more deaths—and more funerals.
As we were listening to the report, I looked over at Emile, who was absorbing all the details and asking thoughtful questions. I was glad he was there so he could return home and share what he had learned about the seriousness of the situation in a way other people might be able to understand.
Oxfam had jumped in to supply ever-scarce fuel and supplies for the response. While everyone hopes this epidemic is winding down, no one was surprised that that there were still cases erupting. The infrastructure in Zimbabwe is so broken down it will take years to build a safe water system for all to use. Our biosand filters—a water treatment method that is used in the household—will provide more long-term protection for families and hopefully prevent diarrhea for them in the coming year.
The filters arrived the other day—thanks to UPS, who shipped them from the US for free—and we swung by the warehouse to look at them: large blue buckets with very little tubing. Their simplicity is amazing. I had drawn a picture for Emile the night before and explained how they worked. When he saw them in person, his eyes lit up: it all came together. I was happy to see someone who was just as excited as me about these blue plastic buckets and their potential to save lives.
We spent the night talking about the trip—all the things we saw and experienced. I pulled out my computer and we had a discussion, using a power point lecture, about the role of evidence in humanitarian response: How do you set up an early warning surveillance? Why is it so complicated? Why is it so important? I could see that Emile was synthesizing all the things he had learned over the past week, putting them together and grasping the complexities that make up Zimbabwe.
I am looking forward to reading what he writes. I am sure I will learn something from him and can't wait.
]]>