Sidney Coupet, DO, MPHRobert Wood Johnson Foundation Clinical Scholar

Department of Internal MedicineUniversity of Michigan

Doctors United For Haiti (DUFH)Founder and Executive Director

Haiti Cholera: The introduction of an inclusive implementation model on Water Quality, Vaccination and Education.

A Comprehensive solution for Policymakers.

Topics for Discussion

The steps to discovering a solution

1Cholera in Haiti

2Proposed Model

3The Projected impact

Haiti’s Cholera Epidemic

Introduced to Haiti October, 2010 and is expected to remain.

1

-POOREST NATION IN THE WESTERN HEMISPHERE.

-40% OF THE POPULATION RELY STRICTLY ON TRADITIONAL HEALERS.

-INADEQUATE SANITATION SYSTEMS AND NO RELIABLE SAFE WATER SUPPLY IN MOST PARTS OF THE COUNTRY.

-ANY MAJOR STORM CAN PRODUCE SERIOUS FLOODING AND SUBSEQUENTLY TRANSMIT RELATED INFECTIOUS DISEASES AND WATER BORNE ILLNESSES.

-DIARRHEA AND INTESTINAL DISEASE DEATH RATE IS 31.97% COMPARE TO US 7.35%.

Fertile Environment for Cholera

JANUARY, 12, 2010 HAITI’S DEVASTATING EARTHQUAKE

-LOST OF AT LEAST 300 HEALTH CARE PROVIDERS

-OVER 2 MILLION DISPLACED AND LIVING IN TENT CITIES IN CLOSE QUARTERS

-MASSIVE DISTRUCTION OF HEALTHCARE RELATED INFRASTUCTURES (HOSPITALS/CLINICS/DISPENCERIES/MINISTRIES OFFICES)

-MASSIVE INFLUX OF INTERNATIONAL AID

A window of opportunity for Cholera

Over 300,000 infected and >5,000 deaths so far.

Current InterventionsCTC for acute careWater chlorinationDissemination of health information through mass media

Despite the above interventions Morbidity and Mortality are still rising.

Controversies surrounding the Cholera Vaccination has delay its use in the country.

Cholera’s Impact /Interventions /Missed Opportunities

Cholera Vaccination?

• Short stock pile of the vaccination (Dukarol/Shanchol:200,000)

• Requires 2 doses or 1 dose• 80% protective for 3 years• Liquid and orally administered• Requires 2-8 degrees Celsius• General gaps

– Vaccination dissemination– Limited stock pile– Shortage of healthcare workforce– Storage

2 The Proposed inclusive Implementation Model.

Increases the reach of all Cholera Interventions

The Best Cholera Intervention is Comprehensive

Coupet/Nassiri Model: 9/2011

The Haiti Proposed Key Players Inclusive Implementation Model for Cholera Intervention.

Key PlayersCommunity Health workers

Haitian Healthcare ProvidersPublic health Officials

Traditional healersPhysician/nurse partners abroad

Vaccination

Water Screening

for Cholera

Education Acute Care

Integrated Inclusive Model: Coupet/Nassiri

The Proposed Model’s Logistical Approach

– Planning• We will devise a course of action that will match using geographic locations to partner

health facilities with near by traditional healers. We will also provide the traditional healers education at the sites.

– Engaging • We will use volunteers who live in the communities and patients who were recently

affected by cholera to identify a traditional healer in the area. We will also use a snowball effect to recruit other traditional healers.

– Executing• We will have a highly trained public health official function as a liaison between the health

centers and the traditional healers.

– Reflecting and Evaluating• We will measure the participation rate of traditional healers and willingness of Faith Base

Organizations (FBO) , Non-Governmental Organizations (NGOs) and Minister of Health (MSPP) to work with traditional healers.

• We will evaluate the feasibility of traditional healers serving a role in educating, referring patients and administering vaccine.

• Evaluating the outcomes of involvement of Healthcare Volunteers from abroad.Realization of the Added Value of the Inclusive Model

3 The Projected Impact of the Inclusive Implementation Model.

Expanding The Reach of all Cholera Interventions

The Haiti Proposed Key Players Inclusive Implementation Model

for Cholera Intervention.

Key PlayersCommunity Health workers

Haitian Healthcare ProvidersPublic health Officials

Traditional healersPhysician/nurse partners abroad

Vaccination

Water Screening

for Cholera

Education Acute Care

IMPACTReduced cholera morbidity and

mortality,Healthier

populations,Reduction in

workforce “downtime”

Model Suggested by: Coupet/Nassiri

Measured Impact of Key Players

Key Players Education Vaccination Water Screening for

Cholera

Acute Care

Community Workers in Haiti

+++++ +++++ ++++ +

Physician/Nurse Providers in

Haiti

+++++ +++++ +++ +++++

Public Health Officials

+++++ +++++ +++++ +

Traditional Healers

+++++ +++++ ++++ +++

Physician/Nurse partners abroad.

+++++ +++++ ++ +++++

Opportunity for One Health Approach

-Everyone will be able to serve as an anchor to expanding the reach of any cholera intervention. -Capitalizing on already established trust with communities, -Enhance the effectiveness of any proposed comprehensive intervention for cholera

It’s about team work.

Collaboration

Our Integrated Academic Approach is in part a step towards the introduction of One Health

Approach in Haiti.