notes: 12/16/10 Post on HEAS from Amber Munger The community health committee reports that the La Source Chaude clinic is being well attended by MSF-France. In the past two weeks, new tents have been added to the clinic property (totaling 3). One is being used as a depot for materials, the other two host patients. MSF has provided beds and other helpful materials for the full operation of the CTU. MSF is also supporting 5 nurses at this clinic which, prior to the outbreak, had no competent medical professionals. Yesterday, when A29's coordinator gathered the report from the committee, there were only 8 patients at the clinic. One patient had died earlier that morning (for a total of 9 patients that day). The village of La Source Chaude is the main market-trading village for the region. This market, which meets twice a week, usually attracting people from far away villages the night before, has no public latrine, creating a public health hazard and threatening the potability of the water. The community has mobilized together for the placement of a latrine near the market and they have dug the initial pit for the latrine. To complete the latrine, funds are needed for materials and masons. A29 seeks an NGO partner for latrine building, or funds so that it can facilitate the construction of the latrine with community leaders. Although the numbers have stabilized and even decreased in Communes Anse Rouge and Terre Neuve, we still have preventable cholera deaths on a regular, daily basis, due to a lack of education about cholera prevention and treatment. A29 is supporting a house to house community education campaign in 22 hard to reach villages in the region. We are seeking partnership with a health based NGO who has medical staff that can give a two day training for 30 cholera agents, supported by A29. We also seek support in the form of informative leaflets that can be left with each household, aqua-tab and soap. If other health based NGOs are able to provide other forms of support to the region, A29 would be happy to facilitate the implementation of health based programs in the region. We have a good relationship with an extensive community network of peasant groups that reach every corner of Communes Anse Rouge and third section Terre Neuve. --------------------------------------------------- 12/6/10 Email from Amber Munger Karine from MSF emailed me today and said that ORS/OPS had also sent supplies to the Lagon clinic. I dont know who that is or what supplies. In the meantime, AMURT is reporting that they sent a doctor to La Source Chaude that was there for three days, but I did not hear this from Hebert or MSPP. --------------------------------------- 11/4/10 Email from Dr. Grazia Caleo, PAHO Gonaive I am based in Gonaive for PAHO/OMS. I am following the alert situation in the Haut Artibonite. Regarding the situation in Anse Rouge I contacted MSF France they told me that in Source Chaude they set up a UTC in Anse Rouge a points ORS. Also they regularly provide support and supply. (LPar Note: Amber is contacting MSF to coord. and clarify what their support will be. Supply drop was noted in 12/2/10 entry. Staff support needs to be clarified.) ---------------------------------------------- 12/2/10: From conversation with Amber Market days are twice a week Thurs. and Sat. Missionary Air Sities uses airstrip. We were also able to hook them up with CARE for educational materials! Herbert has a meeting with them set up. ------------------------------------------------- 12/2/10 Email from Amber Munger ...still waiting for verifiable information. The volunteer nurse auxiliary in the La Source Chaude Clinic is refusing to give A29 or the community health committee information on cholera patients because we won't provide him with a salary or other means of compensation. As I mentioned before, the nurse auxiliary is a volunteer that does not have a good relationship with the community but is the only medical personnel that the community has. The Communal Director for MSPP (Dr. Carlo) is meeting with the community health committee, community leadership council, A29, and the nurse auxiliary on Friday to resolve the issue. A29's coordinator, Hebert Pierre, at this point can only verify the number of patients that he has seen at the clinic while he has been present in La Source for the last week. In general, the La Source Chaude clinic has had about 15-19 overnight cholera patients per day for the last five days at the CTC. We can confirm, too, that MSF brought 9 boxes of supplies, (presumably hydration fluid) (this is in addition to a large tent and small amt. of supplies that MSPP dropped off after 63 patients were transported)to the La Source Chaude clinic yesterday. After the meeting on Friday I will be able to give an inventory report on what was given. In terms of the Town of Anse Rouge, as I mentioned before, Hebert said that that clinic is closed. When he went to the clinic again on Tuesday to get information there was only a guardian there who could not provide him with any information. He is hoping to establish more formalised lines of communication today and tomorrow as he meets with CARE - who contacted him yesterday - and MSPP on Friday at the community meeting. ------------------------------------------- 11/22/10 Notes from Amber Hebert has not yet even met with the organization in PAP to know what supplies we will get . That appointment is at 10:00 today. The we still ahve to figure out transport for the supplies. As soon as we receive supplies I will let you know. These supplies will be for the La SOurce Chaude clinic FIRST and anything we can spare we will give to teh CIty Clinic. The City Clinic is on Route National One and patients can more easily find transport to Gonaives from that Center. That is not the case where we are in La SOurce Chaude. We need to have supplies at the La SOurce Chaude clinic because those people will not be able to make it to another location easily. It was a blessing that MSPP had a truck available to send to La Source last time. I dont think our luck wil be the same next time around. Water - the La Source Chaude clinic has water as we have hot springs in la Source Chaude (which means, in French, "hot spring"). The nurse auxillary who works there is highly incompetent and does not use the water filter that was set up for the clinic because he does not like the person who installed it. If he decided to use it again it has to be reinstalled and will be at least a few weeks before it is up and running. So we need aquatab or other water disinfectant for the clinic (as well as for the population in general). ---------------------------------------------- 11/21/10 Update on Assessment from Amber Munger When did cholera patients begin to come at this location? 9 or 10 November How many people does your facility serve? There are approximately 37,000 people in Commune Anse Rouge. Normally, the La SOurce Chaude clinic services about 1/6 of the population. Now that all other clinics except the one in the City of Anse Rouge have closed, people are coming from throughout the commune to the La Source Chaude clinic. Current Cholera Patient Load Up until November 18th there were only five cases (all of whom died). However, yesterday 63 patients walked or were transported to the La Source Chaude clinic many of them walking from extremely remote locations where they were expected to have brought cholera from Port-de-Paix. Most of the patients were coming from Tante, Yaya and Bonsinye, extremely high mountain regions that border third section Port-de-Paix. Fatality Rate for Cholera? Five of the five patients who had cholera until November 18th died; one is suspected of intentionally polluting the water source when he was shut out of the clinics, spreading cholera to three other people in the village of Kay Felip. Yesterday, November 20th one patient died and then 63 more people proceeded arrive at teh clinic. These people were transported in a MSPP truck to Gonaives. No one died en route but we are unclear as to what happened after they were deposited in Gonaives. Has number of patients stabilized? Today there were only seven patients in total. Yesterday was market day and people came from very far to the La Source market, explaining the huge increase in numbers. Medical Staffing (eg. no. of Doctors, no. of Nurses, no. of non medical staff): The community health clinic has no paid staff. There is only a volunteer nurse auxillary at the clinic. There are no qualified medical proffessionals (doctors or nurses) in the entire second section Commune Anse Rouge and only one that we know of in the first section. How many patients are you treating daily? Will update in a few days. How many hospitalized? Just transported all patients Does your facility provide Mobile Medical Clinics to the community?we do not have transportation available What is your Cholera Bed Capacity? There were only five beds in the La SOurce clinic. MSPP sent a tent for the clinic to set up in the lakou but have not provided beds. Describe accessibility to your site (e.g. Passable roads? Helicopter Landing Pad or spot? Airstrip for small planes? Please provide conditions for air landings and GPS coordinates). By road, it is a 2 hour trip from Gonaives (one hour on route national one and another hour on teh road from Letan to La Source Chaude). It is a very difficult road, even by Haiti standards. There is a helicopter landing strip in the City of Anse Rouge, which is a one hour drive from La Source Chaude, but is a much easier drive than the trip from Gonaives. Can you pick up supplies? We can pay local trucks to retrieve the supplies. THe local leaders in the community will offer the use of their large transport vehicles. Medical Supply needs (List by PRIORITY please). cholera related supplies and disinfectants. The clinic is also lacking in basic antibiotics for most other treatable illnesses. ---------------------------------------- 11/21/10 Email from Amber Hi folks - Just a quick update on this. Yesterday 63 patients showed up at the La Sources Chaude clinic after noon because all other clinics in Commune Anse Rouge (except for the one in the City of Anse Rouge) closed their doors to cholera patients. A29 Coordinator lobbied MSPP in Gonaives for help. In response, MSPP sent a truck to La Source Chaude to transport the 63 patients to Gonaives. Our coordinator said there were only a few patients who came to the La Source Clinic this morning before he left for PAP to try to seek medical supplies. MSPP sent us some fluid and IVs as well as a tent to set up a CTC in the lakou of the La Sous Clinic. The supplies will not last long. Hebert is in PAP meeting with Americare to see if they would be willing to give us free antibiotics, fluids, clorox for disinfecting the center, and aquatab. As I mentioned before, there are no qualified medical personnel in second section Commune Anse Rouge, and I am not sure that there are any either in the first section either (other than the regional director, who is helping to coordinate rather than see patients). ----------------------------------------- 11/21/10 Email from Amber I am on a call until 8:00 when I will get back to this but for now I wanted to make clear that A29 does not represent the ILODEP clinic. A29 is trying to find support for the community clinics - not the private clinic run by a private organization. I just received word that even the ILODEP clinic closed, just as all of the other private clinics. The private clinics will not accept cholera patients. Since I last wrote you yesterday, the La SOurce Chaude clinic received 63 patients - because all of the other clinics in the entire commune closed except for the City of Anse Rouge clinic which has no materials. Since the La SOurce Chaude clinic also had no materials, our coordinator Hebert Pierre worked with the Ministry of Health to try to find transport to Gonaives for all 63 of the patients. Gonaives is a treacherous two hour drive from La Source Chaude, and not many vehicles make the voyage. I will fill out the information on the sheet that you sent me just as soon as I am off the call with my board. Thanks for your help! ------------------------------------------- 11/21/10 Have requested Assesment information from Amber for clinic. lpar ------------------------------------------- Email from Amber Munger of Article 29 Organization 11/21/10 Commune Anse Rouge has approximately 37,000 residents but also services parts of Terre Neuve, raising the number to about 42,000. Article 29 Organization's base is in Second Section Commune Anse Rouge, which has four physical health clinics. One is the ILODEP clinic sponsored by Parole et Action, the other three are community clinics which have no paid staff and have not received supplies since July, the last time that A29 secured supplies for distribution to the clinics. There is no doctor or nurse in second section Commune Anse Rouge. There is rumored to be a doctor present in the City of Anse Rouge at the tent clinic (in first section Commune Anse Rouge) at the site of the old hospital that burnt down last year. This clinic is between a 2 to 8 hour walk for people in Second Section Commune Anse Rouge and there are virtually no taptaps or cars in the region. Cholera first entered Second Section Commune Anse Rouge about two weeks ago with cases coming in from people who had been in Gonaives. In second Section Commune Anse Rouge, we had five cases last week. The La Source Chaude clinic, which is the main clinic for the second section and is run by a volunteer nurse auxillary, closed its doors for fear of cholera. All five cholera victims died. A29's coordinator lobbied regional MSPP to re-open the clinic, which the volunteer nurse auxillary has now done, but there are currently no supplies (IV's, hydration fluids, antibiotics) to treat patients. Thus, more patients have arrived at the clinic, receive a cholera diagnosis, and then die. By the time the patients arrive at the clinic they have been too far along to respond to ORS, so IVs are needed. There are very few cars in the region so it is difficult to get patients to the City of Anse Rouge clinic, which as of yesterday was also out of IVs and rehydration fluids. As of yesterday, at least five more cholera patients found transport from SEcond Section Commune Anse Rouge to the City of Anse Rouge clinic in the first section. Two more died at the La Source Chaude clinic in Second Section. Five new patients had arrived at the La Source Clinic yesterday. A29 launched a public education and prevention campaign two weeks ago at teh regions two largest public markets (the City of Anse Rouge and the La Source Chaude markets). Information is spread by megaphone regarding prevention of cholera, treatment and how and when to make ORS. As a result of the outbreak in Gonaives, people are afraid to go to Gonaives for fear of contracting cholera. This puts the entire region in a precarious position as most of the region's supplies are procured in Gonaives (rice, oil, gas, everything). Commune Anse Rouge produces shallot and sourghum and pwa congo but no other crops in sufficient quantity to meet people's basic dietary needs - everything comes from Gonaives. There have been reports that one of the first two cholera victims in the region, when being shut out by the clinic and the community, deliberately polluted the drinking water source in Kay Felip, causing the other three people (of the initial five people) to contract cholera. There is a lot of panic and fear as a result, which could all easily be assuaged with the presence of a qualified doctor or nurse and some cholera medical supplies. A29 is currently engaged in efforts to secure supplies and transport for cholera treatment from PAP but has met with great challenges thus far. A29 is also attempting to engage medical teams to bring support to the region, which almost never receives such assistance because of its isolated location NW of Gonaives. -> 1/2/11: Email from Amber The cholera cases have decreased significantly but we are still discovering little pockets where the epidemic is causing lots of harm. For example, there was one village Habert discovered about a month ago where three people died during his brief visit of a few hours. THe village was impossible to get to with a car. Hebert brought the village to the attention of MSF, MSPP and IOM. IOM sent in some folks with supplies. We are now concentrating on spreading our house-to-house education campaign and questionnaire throughout the commune. We are also working with the community to develop a health program for the Lagon and La Source Chaude clinics. We are currently receiving supplies from Americares. ----------------------------------- 12/16/10 Post on HEAS from Amber Munger The community health committee reports that the La Source Chaude clinic is being well attended by MSF-France. In the past two weeks, new tents have been added to the clinic property (totaling 3). One is being used as a depot for materials, the other two host patients. MSF has provided beds and other helpful materials for the full operation of the CTU. MSF is also supporting 5 nurses at this clinic which, prior to the outbreak, had no competent medical professionals. Yesterday, when A29's coordinator gathered the report from the committee, there were only 8 patients at the clinic. One patient had died earlier that morning (for a total of 9 patients that day). The village of La Source Chaude is the main market-trading village for the region. This market, which meets twice a week, usually attracting people from far away villages the night before, has no public latrine, creating a public health hazard and threatening the potability of the water. The community has mobilized together for the placement of a latrine near the market and they have dug the initial pit for the latrine. To complete the latrine, funds are needed for materials and masons. A29 seeks an NGO partner for latrine building, or funds so that it can facilitate the construction of the latrine with community leaders. Although the numbers have stabilized and even decreased in Communes Anse Rouge and Terre Neuve, we still have preventable cholera deaths on a regular, daily basis, due to a lack of education about cholera prevention and treatment. A29 is supporting a house to house community education campaign in 22 hard to reach villages in the region. We are seeking partnership with a health based NGO who has medical staff that can give a two day training for 30 cholera agents, supported by A29. We also seek support in the form of informative leaflets that can be left with each household, aqua-tab and soap. If other health based NGOs are able to provide other forms of support to the region, A29 would be happy to facilitate the implementation of health based programs in the region. We have a good relationship with an extensive community network of peasant groups that reach every corner of Communes Anse Rouge and third section Terre Neuve. --------------------------------------------------- 12/6/10 Email from Amber Munger Karine from MSF emailed me today and said that ORS/OPS had also sent supplies to the Lagon clinic. I dont know who that is or what supplies. In the meantime, AMURT is reporting that they sent a doctor to La Source Chaude that was there for three days, but I did not hear this from Hebert or MSPP. --------------------------------------- 11/4/10 Email from Dr. Grazia Caleo, PAHO Gonaive I am based in Gonaive for PAHO/OMS. I am following the alert situation in the Haut Artibonite. Regarding the situation in Anse Rouge I contacted MSF France they told me that in Source Chaude they set up a UTC in Anse Rouge a points ORS. Also they regularly provide support and supply. (LPar Note: Amber is contacting MSF to coord. and clarify what their support will be. Supply drop was noted in 12/2/10 entry. Staff support needs to be clarified.) ---------------------------------------------- 12/2/10: From conversation with Amber Market days are twice a week Thurs. and Sat. Missionary Air Sities uses airstrip. We were also able to hook them up with CARE for educational materials! Herbert has a meeting with them set up. ------------------------------------------------- 12/2/10 Email from Amber Munger ...still waiting for verifiable information. The volunteer nurse auxiliary in the La Source Chaude Clinic is refusing to give A29 or the community health committee information on cholera patients because we won't provide him with a salary or other means of compensation. As I mentioned before, the nurse auxiliary is a volunteer that does not have a good relationship with the community but is the only medical personnel that the community has. The Communal Director for MSPP (Dr. Carlo) is meeting with the community health committee, community leadership council, A29, and the nurse auxiliary on Friday to resolve the issue. A29's coordinator, Hebert Pierre, at this point can only verify the number of patients that he has seen at the clinic while he has been present in La Source for the last week. In general, the La Source Chaude clinic has had about 15-19 overnight cholera patients per day for the last five days at the CTC. We can confirm, too, that MSF brought 9 boxes of supplies, (presumably hydration fluid) (this is in addition to a large tent and small amt. of supplies that MSPP dropped off after 63 patients were transported)to the La Source Chaude clinic yesterday. After the meeting on Friday I will be able to give an inventory report on what was given. In terms of the Town of Anse Rouge, as I mentioned before, Hebert said that that clinic is closed. When he went to the clinic again on Tuesday to get information there was only a guardian there who could not provide him with any information. He is hoping to establish more formalised lines of communication today and tomorrow as he meets with CARE - who contacted him yesterday - and MSPP on Friday at the community meeting. ------------------------------------------- 11/22/10 Notes from Amber Hebert has not yet even met with the organization in PAP to know what supplies we will get . That appointment is at 10:00 today. The we still ahve to figure out transport for the supplies. As soon as we receive supplies I will let you know. These supplies will be for the La SOurce Chaude clinic FIRST and anything we can spare we will give to teh CIty Clinic. The City Clinic is on Route National One and patients can more easily find transport to Gonaives from that Center. That is not the case where we are in La SOurce Chaude. We need to have supplies at the La SOurce Chaude clinic because those people will not be able to make it to another location easily. It was a blessing that MSPP had a truck available to send to La Source last time. I dont think our luck wil be the same next time around. Water - the La Source Chaude clinic has water as we have hot springs in la Source Chaude (which means, in French, "hot spring"). The nurse auxillary who works there is highly incompetent and does not use the water filter that was set up for the clinic because he does not like the person who installed it. If he decided to use it again it has to be reinstalled and will be at least a few weeks before it is up and running. So we need aquatab or other water disinfectant for the clinic (as well as for the population in general). ---------------------------------------------- 11/21/10 Update on Assessment from Amber Munger When did cholera patients begin to come at this location? 9 or 10 November How many people does your facility serve? There are approximately 37,000 people in Commune Anse Rouge. Normally, the La SOurce Chaude clinic services about 1/6 of the population. Now that all other clinics except the one in the City of Anse Rouge have closed, people are coming from throughout the commune to the La Source Chaude clinic. Current Cholera Patient Load Up until November 18th there were only five cases (all of whom died). However, yesterday 63 patients walked or were transported to the La Source Chaude clinic many of them walking from extremely remote locations where they were expected to have brought cholera from Port-de-Paix. Most of the patients were coming from Tante, Yaya and Bonsinye, extremely high mountain regions that border third section Port-de-Paix. Fatality Rate for Cholera? Five of the five patients who had cholera until November 18th died; one is suspected of intentionally polluting the water source when he was shut out of the clinics, spreading cholera to three other people in the village of Kay Felip. Yesterday, November 20th one patient died and then 63 more people proceeded arrive at teh clinic. These people were transported in a MSPP truck to Gonaives. No one died en route but we are unclear as to what happened after they were deposited in Gonaives. Has number of patients stabilized? Today there were only seven patients in total. Yesterday was market day and people came from very far to the La Source market, explaining the huge increase in numbers. Medical Staffing (eg. no. of Doctors, no. of Nurses, no. of non medical staff): The community health clinic has no paid staff. There is only a volunteer nurse auxillary at the clinic. There are no qualified medical proffessionals (doctors or nurses) in the entire second section Commune Anse Rouge and only one that we know of in the first section. How many patients are you treating daily? Will update in a few days. How many hospitalized? Just transported all patients Does your facility provide Mobile Medical Clinics to the community?we do not have transportation available What is your Cholera Bed Capacity? There were only five beds in the La SOurce clinic. MSPP sent a tent for the clinic to set up in the lakou but have not provided beds. Describe accessibility to your site (e.g. Passable roads? Helicopter Landing Pad or spot? Airstrip for small planes? Please provide conditions for air landings and GPS coordinates). By road, it is a 2 hour trip from Gonaives (one hour on route national one and another hour on teh road from Letan to La Source Chaude). It is a very difficult road, even by Haiti standards. There is a helicopter landing strip in the City of Anse Rouge, which is a one hour drive from La Source Chaude, but is a much easier drive than the trip from Gonaives. Can you pick up supplies? We can pay local trucks to retrieve the supplies. THe local leaders in the community will offer the use of their large transport vehicles. Medical Supply needs (List by PRIORITY please). cholera related supplies and disinfectants. The clinic is also lacking in basic antibiotics for most other treatable illnesses. ---------------------------------------- 11/21/10 Email from Amber Hi folks - Just a quick update on this. Yesterday 63 patients showed up at the La Sources Chaude clinic after noon because all other clinics in Commune Anse Rouge (except for the one in the City of Anse Rouge) closed their doors to cholera patients. A29 Coordinator lobbied MSPP in Gonaives for help. In response, MSPP sent a truck to La Source Chaude to transport the 63 patients to Gonaives. Our coordinator said there were only a few patients who came to the La Source Clinic this morning before he left for PAP to try to seek medical supplies. MSPP sent us some fluid and IVs as well as a tent to set up a CTC in the lakou of the La Sous Clinic. The supplies will not last long. Hebert is in PAP meeting with Americare to see if they would be willing to give us free antibiotics, fluids, clorox for disinfecting the center, and aquatab. As I mentioned before, there are no qualified medical personnel in second section Commune Anse Rouge, and I am not sure that there are any either in the first section either (other than the regional director, who is helping to coordinate rather than see patients). ----------------------------------------- 11/21/10 Email from Amber I am on a call until 8:00 when I will get back to this but for now I wanted to make clear that A29 does not represent the ILODEP clinic. A29 is trying to find support for the community clinics - not the private clinic run by a private organization. I just received word that even the ILODEP clinic closed, just as all of the other private clinics. The private clinics will not accept cholera patients. Since I last wrote you yesterday, the La SOurce Chaude clinic received 63 patients - because all of the other clinics in the entire commune closed except for the City of Anse Rouge clinic which has no materials. Since the La SOurce Chaude clinic also had no materials, our coordinator Hebert Pierre worked with the Ministry of Health to try to find transport to Gonaives for all 63 of the patients. Gonaives is a treacherous two hour drive from La Source Chaude, and not many vehicles make the voyage. I will fill out the information on the sheet that you sent me just as soon as I am off the call with my board. Thanks for your help! ------------------------------------------- 11/21/10 Have requested Assesment information from Amber for clinic. lpar ------------------------------------------- Email from Amber Munger of Article 29 Organization 11/21/10 Commune Anse Rouge has approximately 37,000 residents but also services parts of Terre Neuve, raising the number to about 42,000. Article 29 Organization's base is in Second Section Commune Anse Rouge, which has four physical health clinics. One is the ILODEP clinic sponsored by Parole et Action, the other three are community clinics which have no paid staff and have not received supplies since July, the last time that A29 secured supplies for distribution to the clinics. There is no doctor or nurse in second section Commune Anse Rouge. There is rumored to be a doctor present in the City of Anse Rouge at the tent clinic (in first section Commune Anse Rouge) at the site of the old hospital that burnt down last year. This clinic is between a 2 to 8 hour walk for people in Second Section Commune Anse Rouge and there are virtually no taptaps or cars in the region. Cholera first entered Second Section Commune Anse Rouge about two weeks ago with cases coming in from people who had been in Gonaives. In second Section Commune Anse Rouge, we had five cases last week. The La Source Chaude clinic, which is the main clinic for the second section and is run by a volunteer nurse auxillary, closed its doors for fear of cholera. All five cholera victims died. A29's coordinator lobbied regional MSPP to re-open the clinic, which the volunteer nurse auxillary has now done, but there are currently no supplies (IV's, hydration fluids, antibiotics) to treat patients. Thus, more patients have arrived at the clinic, receive a cholera diagnosis, and then die. By the time the patients arrive at the clinic they have been too far along to respond to ORS, so IVs are needed. There are very few cars in the region so it is difficult to get patients to the City of Anse Rouge clinic, which as of yesterday was also out of IVs and rehydration fluids. As of yesterday, at least five more cholera patients found transport from SEcond Section Commune Anse Rouge to the City of Anse Rouge clinic in the first section. Two more died at the La Source Chaude clinic in Second Section. Five new patients had arrived at the La Source Clinic yesterday. A29 launched a public education and prevention campaign two weeks ago at teh regions two largest public markets (the City of Anse Rouge and the La Source Chaude markets). Information is spread by megaphone regarding prevention of cholera, treatment and how and when to make ORS. As a result of the outbreak in Gonaives, people are afraid to go to Gonaives for fear of contracting cholera. This puts the entire region in a precarious position as most of the region's supplies are procured in Gonaives (rice, oil, gas, everything). Commune Anse Rouge produces shallot and sourghum and pwa congo but no other crops in sufficient quantity to meet people's basic dietary needs - everything comes from Gonaives. There have been reports that one of the first two cholera victims in the region, when being shut out by the clinic and the community, deliberately polluted the drinking water source in Kay Felip, causing the other three people (of the initial five people) to contract cholera. There is a lot of panic and fear as a result, which could all easily be assuaged with the presence of a qualified doctor or nurse and some cholera medical supplies. A29 is currently engaged in efforts to secure supplies and transport for cholera treatment from PAP but has met with great challenges thus far. A29 is also attempting to engage medical teams to bring support to the region, which almost never receives such assistance because of its isolated location NW of Gonaives.
other_contacts changed.

notes: 12/16/10 Post on HEAS from Amber Munger The community health committee reports that the La Source Chaude clinic is being well attended by MSF-France. In the past two weeks, new tents have been added to the clinic property (totaling 3). One is being used as a depot for materials, the other two host patients. MSF has provided beds and other helpful materials for the full operation of the CTU. MSF is also supporting 5 nurses at this clinic which, prior to the outbreak, had no competent medical professionals. Yesterday, when A29's coordinator gathered the report from the committee, there were only 8 patients at the clinic. One patient had died earlier that morning (for a total of 9 patients that day). The village of La Source Chaude is the main market-trading village for the region. This market, which meets twice a week, usually attracting people from far away villages the night before, has no public latrine, creating a public health hazard and threatening the potability of the water. The community has mobilized together for the placement of a latrine near the market and they have dug the initial pit for the latrine. To complete the latrine, funds are needed for materials and masons. A29 seeks an NGO partner for latrine building, or funds so that it can facilitate the construction of the latrine with community leaders. --------------------------------------------------- 12/6/10 Email from Amber Munger Karine from MSF emailed me today and said that ORS/OPS had also sent supplies to the Lagon clinic. I dont know who that is or what supplies. In the meantime, AMURT is reporting that they sent a doctor to La Source Chaude that was there for three days, but I did not hear this from Hebert or MSPP. --------------------------------------- 11/4/10 Email from Dr. Grazia Caleo, PAHO Gonaive I am based in Gonaive for PAHO/OMS. I am following the alert situation in the Haut Artibonite. Regarding the situation in Anse Rouge I contacted MSF France they told me that in Source Chaude they set up a UTC in Anse Rouge a points ORS. Also they regularly provide support and supply. (LPar Note: Amber is contacting MSF to coord. and clarify what their support will be. Supply drop was noted in 12/2/10 entry. Staff support needs to be clarified.) ---------------------------------------------- 12/2/10: From conversation with Amber Market days are twice a week Thurs. and Sat. Missionary Air Sities uses airstrip. We were also able to hook them up with CARE for educational materials! Herbert has a meeting with them set up. ------------------------------------------------- 12/2/10 Email from Amber Munger ...still waiting for verifiable information. The volunteer nurse auxiliary in the La Source Chaude Clinic is refusing to give A29 or the community health committee information on cholera patients because we won't provide him with a salary or other means of compensation. As I mentioned before, the nurse auxiliary is a volunteer that does not have a good relationship with the community but is the only medical personnel that the community has. The Communal Director for MSPP (Dr. Carlo) is meeting with the community health committee, community leadership council, A29, and the nurse auxiliary on Friday to resolve the issue. A29's coordinator, Hebert Pierre, at this point can only verify the number of patients that he has seen at the clinic while he has been present in La Source for the last week. In general, the La Source Chaude clinic has had about 15-19 overnight cholera patients per day for the last five days at the CTC. We can confirm, too, that MSF brought 9 boxes of supplies, (presumably hydration fluid) (this is in addition to a large tent and small amt. of supplies that MSPP dropped off after 63 patients were transported)to the La Source Chaude clinic yesterday. After the meeting on Friday I will be able to give an inventory report on what was given. In terms of the Town of Anse Rouge, as I mentioned before, Hebert said that that clinic is closed. When he went to the clinic again on Tuesday to get information there was only a guardian there who could not provide him with any information. He is hoping to establish more formalised lines of communication today and tomorrow as he meets with CARE - who contacted him yesterday - and MSPP on Friday at the community meeting. ------------------------------------------- 11/22/10 Notes from Amber Hebert has not yet even met with the organization in PAP to know what supplies we will get . That appointment is at 10:00 today. The we still ahve to figure out transport for the supplies. As soon as we receive supplies I will let you know. These supplies will be for the La SOurce Chaude clinic FIRST and anything we can spare we will give to teh CIty Clinic. The City Clinic is on Route National One and patients can more easily find transport to Gonaives from that Center. That is not the case where we are in La SOurce Chaude. We need to have supplies at the La SOurce Chaude clinic because those people will not be able to make it to another location easily. It was a blessing that MSPP had a truck available to send to La Source last time. I dont think our luck wil be the same next time around. Water - the La Source Chaude clinic has water as we have hot springs in la Source Chaude (which means, in French, "hot spring"). The nurse auxillary who works there is highly incompetent and does not use the water filter that was set up for the clinic because he does not like the person who installed it. If he decided to use it again it has to be reinstalled and will be at least a few weeks before it is up and running. So we need aquatab or other water disinfectant for the clinic (as well as for the population in general). ---------------------------------------------- 11/21/10 Update on Assessment from Amber Munger When did cholera patients begin to come at this location? 9 or 10 November How many people does your facility serve? There are approximately 37,000 people in Commune Anse Rouge. Normally, the La SOurce Chaude clinic services about 1/6 of the population. Now that all other clinics except the one in the City of Anse Rouge have closed, people are coming from throughout the commune to the La Source Chaude clinic. Current Cholera Patient Load Up until November 18th there were only five cases (all of whom died). However, yesterday 63 patients walked or were transported to the La Source Chaude clinic many of them walking from extremely remote locations where they were expected to have brought cholera from Port-de-Paix. Most of the patients were coming from Tante, Yaya and Bonsinye, extremely high mountain regions that border third section Port-de-Paix. Fatality Rate for Cholera? Five of the five patients who had cholera until November 18th died; one is suspected of intentionally polluting the water source when he was shut out of the clinics, spreading cholera to three other people in the village of Kay Felip. Yesterday, November 20th one patient died and then 63 more people proceeded arrive at teh clinic. These people were transported in a MSPP truck to Gonaives. No one died en route but we are unclear as to what happened after they were deposited in Gonaives. Has number of patients stabilized? Today there were only seven patients in total. Yesterday was market day and people came from very far to the La Source market, explaining the huge increase in numbers. Medical Staffing (eg. no. of Doctors, no. of Nurses, no. of non medical staff): The community health clinic has no paid staff. There is only a volunteer nurse auxillary at the clinic. There are no qualified medical proffessionals (doctors or nurses) in the entire second section Commune Anse Rouge and only one that we know of in the first section. How many patients are you treating daily? Will update in a few days. How many hospitalized? Just transported all patients Does your facility provide Mobile Medical Clinics to the community?we do not have transportation available What is your Cholera Bed Capacity? There were only five beds in the La SOurce clinic. MSPP sent a tent for the clinic to set up in the lakou but have not provided beds. Describe accessibility to your site (e.g. Passable roads? Helicopter Landing Pad or spot? Airstrip for small planes? Please provide conditions for air landings and GPS coordinates). By road, it is a 2 hour trip from Gonaives (one hour on route national one and another hour on teh road from Letan to La Source Chaude). It is a very difficult road, even by Haiti standards. There is a helicopter landing strip in the City of Anse Rouge, which is a one hour drive from La Source Chaude, but is a much easier drive than the trip from Gonaives. Can you pick up supplies? We can pay local trucks to retrieve the supplies. THe local leaders in the community will offer the use of their large transport vehicles. Medical Supply needs (List by PRIORITY please). cholera related supplies and disinfectants. The clinic is also lacking in basic antibiotics for most other treatable illnesses. ---------------------------------------- 11/21/10 Email from Amber Hi folks - Just a quick update on this. Yesterday 63 patients showed up at the La Sources Chaude clinic after noon because all other clinics in Commune Anse Rouge (except for the one in the City of Anse Rouge) closed their doors to cholera patients. A29 Coordinator lobbied MSPP in Gonaives for help. In response, MSPP sent a truck to La Source Chaude to transport the 63 patients to Gonaives. Our coordinator said there were only a few patients who came to the La Source Clinic this morning before he left for PAP to try to seek medical supplies. MSPP sent us some fluid and IVs as well as a tent to set up a CTC in the lakou of the La Sous Clinic. The supplies will not last long. Hebert is in PAP meeting with Americare to see if they would be willing to give us free antibiotics, fluids, clorox for disinfecting the center, and aquatab. As I mentioned before, there are no qualified medical personnel in second section Commune Anse Rouge, and I am not sure that there are any either in the first section either (other than the regional director, who is helping to coordinate rather than see patients). ----------------------------------------- 11/21/10 Email from Amber I am on a call until 8:00 when I will get back to this but for now I wanted to make clear that A29 does not represent the ILODEP clinic. A29 is trying to find support for the community clinics - not the private clinic run by a private organization. I just received word that even the ILODEP clinic closed, just as all of the other private clinics. The private clinics will not accept cholera patients. Since I last wrote you yesterday, the La SOurce Chaude clinic received 63 patients - because all of the other clinics in the entire commune closed except for the City of Anse Rouge clinic which has no materials. Since the La SOurce Chaude clinic also had no materials, our coordinator Hebert Pierre worked with the Ministry of Health to try to find transport to Gonaives for all 63 of the patients. Gonaives is a treacherous two hour drive from La Source Chaude, and not many vehicles make the voyage. I will fill out the information on the sheet that you sent me just as soon as I am off the call with my board. Thanks for your help! ------------------------------------------- 11/21/10 Have requested Assesment information from Amber for clinic. lpar ------------------------------------------- Email from Amber Munger of Article 29 Organization 11/21/10 Commune Anse Rouge has approximately 37,000 residents but also services parts of Terre Neuve, raising the number to about 42,000. Article 29 Organization's base is in Second Section Commune Anse Rouge, which has four physical health clinics. One is the ILODEP clinic sponsored by Parole et Action, the other three are community clinics which have no paid staff and have not received supplies since July, the last time that A29 secured supplies for distribution to the clinics. There is no doctor or nurse in second section Commune Anse Rouge. There is rumored to be a doctor present in the City of Anse Rouge at the tent clinic (in first section Commune Anse Rouge) at the site of the old hospital that burnt down last year. This clinic is between a 2 to 8 hour walk for people in Second Section Commune Anse Rouge and there are virtually no taptaps or cars in the region. Cholera first entered Second Section Commune Anse Rouge about two weeks ago with cases coming in from people who had been in Gonaives. In second Section Commune Anse Rouge, we had five cases last week. The La Source Chaude clinic, which is the main clinic for the second section and is run by a volunteer nurse auxillary, closed its doors for fear of cholera. All five cholera victims died. A29's coordinator lobbied regional MSPP to re-open the clinic, which the volunteer nurse auxillary has now done, but there are currently no supplies (IV's, hydration fluids, antibiotics) to treat patients. Thus, more patients have arrived at the clinic, receive a cholera diagnosis, and then die. By the time the patients arrive at the clinic they have been too far along to respond to ORS, so IVs are needed. There are very few cars in the region so it is difficult to get patients to the City of Anse Rouge clinic, which as of yesterday was also out of IVs and rehydration fluids. As of yesterday, at least five more cholera patients found transport from SEcond Section Commune Anse Rouge to the City of Anse Rouge clinic in the first section. Two more died at the La Source Chaude clinic in Second Section. Five new patients had arrived at the La Source Clinic yesterday. A29 launched a public education and prevention campaign two weeks ago at teh regions two largest public markets (the City of Anse Rouge and the La Source Chaude markets). Information is spread by megaphone regarding prevention of cholera, treatment and how and when to make ORS. As a result of the outbreak in Gonaives, people are afraid to go to Gonaives for fear of contracting cholera. This puts the entire region in a precarious position as most of the region's supplies are procured in Gonaives (rice, oil, gas, everything). Commune Anse Rouge produces shallot and sourghum and pwa congo but no other crops in sufficient quantity to meet people's basic dietary needs - everything comes from Gonaives. There have been reports that one of the first two cholera victims in the region, when being shut out by the clinic and the community, deliberately polluted the drinking water source in Kay Felip, causing the other three people (of the initial five people) to contract cholera. There is a lot of panic and fear as a result, which could all easily be assuaged with the presence of a qualified doctor or nurse and some cholera medical supplies. A29 is currently engaged in efforts to secure supplies and transport for cholera treatment from PAP but has met with great challenges thus far. A29 is also attempting to engage medical teams to bring support to the region, which almost never receives such assistance because of its isolated location NW of Gonaives. -> 12/16/10 Post on HEAS from Amber Munger The community health committee reports that the La Source Chaude clinic is being well attended by MSF-France. In the past two weeks, new tents have been added to the clinic property (totaling 3). One is being used as a depot for materials, the other two host patients. MSF has provided beds and other helpful materials for the full operation of the CTU. MSF is also supporting 5 nurses at this clinic which, prior to the outbreak, had no competent medical professionals. Yesterday, when A29's coordinator gathered the report from the committee, there were only 8 patients at the clinic. One patient had died earlier that morning (for a total of 9 patients that day). The village of La Source Chaude is the main market-trading village for the region. This market, which meets twice a week, usually attracting people from far away villages the night before, has no public latrine, creating a public health hazard and threatening the potability of the water. The community has mobilized together for the placement of a latrine near the market and they have dug the initial pit for the latrine. To complete the latrine, funds are needed for materials and masons. A29 seeks an NGO partner for latrine building, or funds so that it can facilitate the construction of the latrine with community leaders. Although the numbers have stabilized and even decreased in Communes Anse Rouge and Terre Neuve, we still have preventable cholera deaths on a regular, daily basis, due to a lack of education about cholera prevention and treatment. A29 is supporting a house to house community education campaign in 22 hard to reach villages in the region. We are seeking partnership with a health based NGO who has medical staff that can give a two day training for 30 cholera agents, supported by A29. We also seek support in the form of informative leaflets that can be left with each household, aqua-tab and soap. If other health based NGOs are able to provide other forms of support to the region, A29 would be happy to facilitate the implementation of health based programs in the region. We have a good relationship with an extensive community network of peasant groups that reach every corner of Communes Anse Rouge and third section Terre Neuve. --------------------------------------------------- 12/6/10 Email from Amber Munger Karine from MSF emailed me today and said that ORS/OPS had also sent supplies to the Lagon clinic. I dont know who that is or what supplies. In the meantime, AMURT is reporting that they sent a doctor to La Source Chaude that was there for three days, but I did not hear this from Hebert or MSPP. --------------------------------------- 11/4/10 Email from Dr. Grazia Caleo, PAHO Gonaive I am based in Gonaive for PAHO/OMS. I am following the alert situation in the Haut Artibonite. Regarding the situation in Anse Rouge I contacted MSF France they told me that in Source Chaude they set up a UTC in Anse Rouge a points ORS. Also they regularly provide support and supply. (LPar Note: Amber is contacting MSF to coord. and clarify what their support will be. Supply drop was noted in 12/2/10 entry. Staff support needs to be clarified.) ---------------------------------------------- 12/2/10: From conversation with Amber Market days are twice a week Thurs. and Sat. Missionary Air Sities uses airstrip. We were also able to hook them up with CARE for educational materials! Herbert has a meeting with them set up. ------------------------------------------------- 12/2/10 Email from Amber Munger ...still waiting for verifiable information. The volunteer nurse auxiliary in the La Source Chaude Clinic is refusing to give A29 or the community health committee information on cholera patients because we won't provide him with a salary or other means of compensation. As I mentioned before, the nurse auxiliary is a volunteer that does not have a good relationship with the community but is the only medical personnel that the community has. The Communal Director for MSPP (Dr. Carlo) is meeting with the community health committee, community leadership council, A29, and the nurse auxiliary on Friday to resolve the issue. A29's coordinator, Hebert Pierre, at this point can only verify the number of patients that he has seen at the clinic while he has been present in La Source for the last week. In general, the La Source Chaude clinic has had about 15-19 overnight cholera patients per day for the last five days at the CTC. We can confirm, too, that MSF brought 9 boxes of supplies, (presumably hydration fluid) (this is in addition to a large tent and small amt. of supplies that MSPP dropped off after 63 patients were transported)to the La Source Chaude clinic yesterday. After the meeting on Friday I will be able to give an inventory report on what was given. In terms of the Town of Anse Rouge, as I mentioned before, Hebert said that that clinic is closed. When he went to the clinic again on Tuesday to get information there was only a guardian there who could not provide him with any information. He is hoping to establish more formalised lines of communication today and tomorrow as he meets with CARE - who contacted him yesterday - and MSPP on Friday at the community meeting. ------------------------------------------- 11/22/10 Notes from Amber Hebert has not yet even met with the organization in PAP to know what supplies we will get . That appointment is at 10:00 today. The we still ahve to figure out transport for the supplies. As soon as we receive supplies I will let you know. These supplies will be for the La SOurce Chaude clinic FIRST and anything we can spare we will give to teh CIty Clinic. The City Clinic is on Route National One and patients can more easily find transport to Gonaives from that Center. That is not the case where we are in La SOurce Chaude. We need to have supplies at the La SOurce Chaude clinic because those people will not be able to make it to another location easily. It was a blessing that MSPP had a truck available to send to La Source last time. I dont think our luck wil be the same next time around. Water - the La Source Chaude clinic has water as we have hot springs in la Source Chaude (which means, in French, "hot spring"). The nurse auxillary who works there is highly incompetent and does not use the water filter that was set up for the clinic because he does not like the person who installed it. If he decided to use it again it has to be reinstalled and will be at least a few weeks before it is up and running. So we need aquatab or other water disinfectant for the clinic (as well as for the population in general). ---------------------------------------------- 11/21/10 Update on Assessment from Amber Munger When did cholera patients begin to come at this location? 9 or 10 November How many people does your facility serve? There are approximately 37,000 people in Commune Anse Rouge. Normally, the La SOurce Chaude clinic services about 1/6 of the population. Now that all other clinics except the one in the City of Anse Rouge have closed, people are coming from throughout the commune to the La Source Chaude clinic. Current Cholera Patient Load Up until November 18th there were only five cases (all of whom died). However, yesterday 63 patients walked or were transported to the La Source Chaude clinic many of them walking from extremely remote locations where they were expected to have brought cholera from Port-de-Paix. Most of the patients were coming from Tante, Yaya and Bonsinye, extremely high mountain regions that border third section Port-de-Paix. Fatality Rate for Cholera? Five of the five patients who had cholera until November 18th died; one is suspected of intentionally polluting the water source when he was shut out of the clinics, spreading cholera to three other people in the village of Kay Felip. Yesterday, November 20th one patient died and then 63 more people proceeded arrive at teh clinic. These people were transported in a MSPP truck to Gonaives. No one died en route but we are unclear as to what happened after they were deposited in Gonaives. Has number of patients stabilized? Today there were only seven patients in total. Yesterday was market day and people came from very far to the La Source market, explaining the huge increase in numbers. Medical Staffing (eg. no. of Doctors, no. of Nurses, no. of non medical staff): The community health clinic has no paid staff. There is only a volunteer nurse auxillary at the clinic. There are no qualified medical proffessionals (doctors or nurses) in the entire second section Commune Anse Rouge and only one that we know of in the first section. How many patients are you treating daily? Will update in a few days. How many hospitalized? Just transported all patients Does your facility provide Mobile Medical Clinics to the community?we do not have transportation available What is your Cholera Bed Capacity? There were only five beds in the La SOurce clinic. MSPP sent a tent for the clinic to set up in the lakou but have not provided beds. Describe accessibility to your site (e.g. Passable roads? Helicopter Landing Pad or spot? Airstrip for small planes? Please provide conditions for air landings and GPS coordinates). By road, it is a 2 hour trip from Gonaives (one hour on route national one and another hour on teh road from Letan to La Source Chaude). It is a very difficult road, even by Haiti standards. There is a helicopter landing strip in the City of Anse Rouge, which is a one hour drive from La Source Chaude, but is a much easier drive than the trip from Gonaives. Can you pick up supplies? We can pay local trucks to retrieve the supplies. THe local leaders in the community will offer the use of their large transport vehicles. Medical Supply needs (List by PRIORITY please). cholera related supplies and disinfectants. The clinic is also lacking in basic antibiotics for most other treatable illnesses. ---------------------------------------- 11/21/10 Email from Amber Hi folks - Just a quick update on this. Yesterday 63 patients showed up at the La Sources Chaude clinic after noon because all other clinics in Commune Anse Rouge (except for the one in the City of Anse Rouge) closed their doors to cholera patients. A29 Coordinator lobbied MSPP in Gonaives for help. In response, MSPP sent a truck to La Source Chaude to transport the 63 patients to Gonaives. Our coordinator said there were only a few patients who came to the La Source Clinic this morning before he left for PAP to try to seek medical supplies. MSPP sent us some fluid and IVs as well as a tent to set up a CTC in the lakou of the La Sous Clinic. The supplies will not last long. Hebert is in PAP meeting with Americare to see if they would be willing to give us free antibiotics, fluids, clorox for disinfecting the center, and aquatab. As I mentioned before, there are no qualified medical personnel in second section Commune Anse Rouge, and I am not sure that there are any either in the first section either (other than the regional director, who is helping to coordinate rather than see patients). ----------------------------------------- 11/21/10 Email from Amber I am on a call until 8:00 when I will get back to this but for now I wanted to make clear that A29 does not represent the ILODEP clinic. A29 is trying to find support for the community clinics - not the private clinic run by a private organization. I just received word that even the ILODEP clinic closed, just as all of the other private clinics. The private clinics will not accept cholera patients. Since I last wrote you yesterday, the La SOurce Chaude clinic received 63 patients - because all of the other clinics in the entire commune closed except for the City of Anse Rouge clinic which has no materials. Since the La SOurce Chaude clinic also had no materials, our coordinator Hebert Pierre worked with the Ministry of Health to try to find transport to Gonaives for all 63 of the patients. Gonaives is a treacherous two hour drive from La Source Chaude, and not many vehicles make the voyage. I will fill out the information on the sheet that you sent me just as soon as I am off the call with my board. Thanks for your help! ------------------------------------------- 11/21/10 Have requested Assesment information from Amber for clinic. lpar ------------------------------------------- Email from Amber Munger of Article 29 Organization 11/21/10 Commune Anse Rouge has approximately 37,000 residents but also services parts of Terre Neuve, raising the number to about 42,000. Article 29 Organization's base is in Second Section Commune Anse Rouge, which has four physical health clinics. One is the ILODEP clinic sponsored by Parole et Action, the other three are community clinics which have no paid staff and have not received supplies since July, the last time that A29 secured supplies for distribution to the clinics. There is no doctor or nurse in second section Commune Anse Rouge. There is rumored to be a doctor present in the City of Anse Rouge at the tent clinic (in first section Commune Anse Rouge) at the site of the old hospital that burnt down last year. This clinic is between a 2 to 8 hour walk for people in Second Section Commune Anse Rouge and there are virtually no taptaps or cars in the region. Cholera first entered Second Section Commune Anse Rouge about two weeks ago with cases coming in from people who had been in Gonaives. In second Section Commune Anse Rouge, we had five cases last week. The La Source Chaude clinic, which is the main clinic for the second section and is run by a volunteer nurse auxillary, closed its doors for fear of cholera. All five cholera victims died. A29's coordinator lobbied regional MSPP to re-open the clinic, which the volunteer nurse auxillary has now done, but there are currently no supplies (IV's, hydration fluids, antibiotics) to treat patients. Thus, more patients have arrived at the clinic, receive a cholera diagnosis, and then die. By the time the patients arrive at the clinic they have been too far along to respond to ORS, so IVs are needed. There are very few cars in the region so it is difficult to get patients to the City of Anse Rouge clinic, which as of yesterday was also out of IVs and rehydration fluids. As of yesterday, at least five more cholera patients found transport from SEcond Section Commune Anse Rouge to the City of Anse Rouge clinic in the first section. Two more died at the La Source Chaude clinic in Second Section. Five new patients had arrived at the La Source Clinic yesterday. A29 launched a public education and prevention campaign two weeks ago at teh regions two largest public markets (the City of Anse Rouge and the La Source Chaude markets). Information is spread by megaphone regarding prevention of cholera, treatment and how and when to make ORS. As a result of the outbreak in Gonaives, people are afraid to go to Gonaives for fear of contracting cholera. This puts the entire region in a precarious position as most of the region's supplies are procured in Gonaives (rice, oil, gas, everything). Commune Anse Rouge produces shallot and sourghum and pwa congo but no other crops in sufficient quantity to meet people's basic dietary needs - everything comes from Gonaives. There have been reports that one of the first two cholera victims in the region, when being shut out by the clinic and the community, deliberately polluted the drinking water source in Kay Felip, causing the other three people (of the initial five people) to contract cholera. There is a lot of panic and fear as a result, which could all easily be assuaged with the presence of a qualified doctor or nurse and some cholera medical supplies. A29 is currently engaged in efforts to secure supplies and transport for cholera treatment from PAP but has met with great challenges thus far. A29 is also attempting to engage medical teams to bring support to the region, which almost never receives such assistance because of its isolated location NW of Gonaives.

notes: 12/16/10 Post on HEAS from Amber Munger The community health committee reports that the La Source Chaude clinic is being well attended by MSF-France. In the past two weeks, new tents have been added to the clinic property (totaling 3). One is being used as a depot for materials, the other two host patients. MSF has provided beds and other helpful materials for the full operation of the CTU. MSF is also supporting 5 nurses at this clinic which, prior to the outbreak, had no competent medical professionals. Yesterday, when A29's coordinator gathered the report from the committee, there were only 8 patients at the clinic. One patient had died earlier that morning (for a total of 9 patients that day). --------------------------------------------------- 12/6/10 Email from Amber Munger Karine from MSF emailed me today and said that ORS/OPS had also sent supplies to the Lagon clinic. I dont know who that is or what supplies. In the meantime, AMURT is reporting that they sent a doctor to La Source Chaude that was there for three days, but I did not hear this from Hebert or MSPP. --------------------------------------- 11/4/10 Email from Dr. Grazia Caleo, PAHO Gonaive I am based in Gonaive for PAHO/OMS. I am following the alert situation in the Haut Artibonite. Regarding the situation in Anse Rouge I contacted MSF France they told me that in Source Chaude they set up a UTC in Anse Rouge a points ORS. Also they regularly provide support and supply. (LPar Note: Amber is contacting MSF to coord. and clarify what their support will be. Supply drop was noted in 12/2/10 entry. Staff support needs to be clarified.) ---------------------------------------------- 12/2/10: From conversation with Amber Market days are twice a week Thurs. and Sat. Missionary Air Sities uses airstrip. We were also able to hook them up with CARE for educational materials! Herbert has a meeting with them set up. ------------------------------------------------- 12/2/10 Email from Amber Munger ...still waiting for verifiable information. The volunteer nurse auxiliary in the La Source Chaude Clinic is refusing to give A29 or the community health committee information on cholera patients because we won't provide him with a salary or other means of compensation. As I mentioned before, the nurse auxiliary is a volunteer that does not have a good relationship with the community but is the only medical personnel that the community has. The Communal Director for MSPP (Dr. Carlo) is meeting with the community health committee, community leadership council, A29, and the nurse auxiliary on Friday to resolve the issue. A29's coordinator, Hebert Pierre, at this point can only verify the number of patients that he has seen at the clinic while he has been present in La Source for the last week. In general, the La Source Chaude clinic has had about 15-19 overnight cholera patients per day for the last five days at the CTC. We can confirm, too, that MSF brought 9 boxes of supplies, (presumably hydration fluid) (this is in addition to a large tent and small amt. of supplies that MSPP dropped off after 63 patients were transported)to the La Source Chaude clinic yesterday. After the meeting on Friday I will be able to give an inventory report on what was given. In terms of the Town of Anse Rouge, as I mentioned before, Hebert said that that clinic is closed. When he went to the clinic again on Tuesday to get information there was only a guardian there who could not provide him with any information. He is hoping to establish more formalised lines of communication today and tomorrow as he meets with CARE - who contacted him yesterday - and MSPP on Friday at the community meeting. ------------------------------------------- 11/22/10 Notes from Amber Hebert has not yet even met with the organization in PAP to know what supplies we will get . That appointment is at 10:00 today. The we still ahve to figure out transport for the supplies. As soon as we receive supplies I will let you know. These supplies will be for the La SOurce Chaude clinic FIRST and anything we can spare we will give to teh CIty Clinic. The City Clinic is on Route National One and patients can more easily find transport to Gonaives from that Center. That is not the case where we are in La SOurce Chaude. We need to have supplies at the La SOurce Chaude clinic because those people will not be able to make it to another location easily. It was a blessing that MSPP had a truck available to send to La Source last time. I dont think our luck wil be the same next time around. Water - the La Source Chaude clinic has water as we have hot springs in la Source Chaude (which means, in French, "hot spring"). The nurse auxillary who works there is highly incompetent and does not use the water filter that was set up for the clinic because he does not like the person who installed it. If he decided to use it again it has to be reinstalled and will be at least a few weeks before it is up and running. So we need aquatab or other water disinfectant for the clinic (as well as for the population in general). ---------------------------------------------- 11/21/10 Update on Assessment from Amber Munger When did cholera patients begin to come at this location? 9 or 10 November How many people does your facility serve? There are approximately 37,000 people in Commune Anse Rouge. Normally, the La SOurce Chaude clinic services about 1/6 of the population. Now that all other clinics except the one in the City of Anse Rouge have closed, people are coming from throughout the commune to the La Source Chaude clinic. Current Cholera Patient Load Up until November 18th there were only five cases (all of whom died). However, yesterday 63 patients walked or were transported to the La Source Chaude clinic many of them walking from extremely remote locations where they were expected to have brought cholera from Port-de-Paix. Most of the patients were coming from Tante, Yaya and Bonsinye, extremely high mountain regions that border third section Port-de-Paix. Fatality Rate for Cholera? Five of the five patients who had cholera until November 18th died; one is suspected of intentionally polluting the water source when he was shut out of the clinics, spreading cholera to three other people in the village of Kay Felip. Yesterday, November 20th one patient died and then 63 more people proceeded arrive at teh clinic. These people were transported in a MSPP truck to Gonaives. No one died en route but we are unclear as to what happened after they were deposited in Gonaives. Has number of patients stabilized? Today there were only seven patients in total. Yesterday was market day and people came from very far to the La Source market, explaining the huge increase in numbers. Medical Staffing (eg. no. of Doctors, no. of Nurses, no. of non medical staff): The community health clinic has no paid staff. There is only a volunteer nurse auxillary at the clinic. There are no qualified medical proffessionals (doctors or nurses) in the entire second section Commune Anse Rouge and only one that we know of in the first section. How many patients are you treating daily? Will update in a few days. How many hospitalized? Just transported all patients Does your facility provide Mobile Medical Clinics to the community?we do not have transportation available What is your Cholera Bed Capacity? There were only five beds in the La SOurce clinic. MSPP sent a tent for the clinic to set up in the lakou but have not provided beds. Describe accessibility to your site (e.g. Passable roads? Helicopter Landing Pad or spot? Airstrip for small planes? Please provide conditions for air landings and GPS coordinates). By road, it is a 2 hour trip from Gonaives (one hour on route national one and another hour on teh road from Letan to La Source Chaude). It is a very difficult road, even by Haiti standards. There is a helicopter landing strip in the City of Anse Rouge, which is a one hour drive from La Source Chaude, but is a much easier drive than the trip from Gonaives. Can you pick up supplies? We can pay local trucks to retrieve the supplies. THe local leaders in the community will offer the use of their large transport vehicles. Medical Supply needs (List by PRIORITY please). cholera related supplies and disinfectants. The clinic is also lacking in basic antibiotics for most other treatable illnesses. ---------------------------------------- 11/21/10 Email from Amber Hi folks - Just a quick update on this. Yesterday 63 patients showed up at the La Sources Chaude clinic after noon because all other clinics in Commune Anse Rouge (except for the one in the City of Anse Rouge) closed their doors to cholera patients. A29 Coordinator lobbied MSPP in Gonaives for help. In response, MSPP sent a truck to La Source Chaude to transport the 63 patients to Gonaives. Our coordinator said there were only a few patients who came to the La Source Clinic this morning before he left for PAP to try to seek medical supplies. MSPP sent us some fluid and IVs as well as a tent to set up a CTC in the lakou of the La Sous Clinic. The supplies will not last long. Hebert is in PAP meeting with Americare to see if they would be willing to give us free antibiotics, fluids, clorox for disinfecting the center, and aquatab. As I mentioned before, there are no qualified medical personnel in second section Commune Anse Rouge, and I am not sure that there are any either in the first section either (other than the regional director, who is helping to coordinate rather than see patients). ----------------------------------------- 11/21/10 Email from Amber I am on a call until 8:00 when I will get back to this but for now I wanted to make clear that A29 does not represent the ILODEP clinic. A29 is trying to find support for the community clinics - not the private clinic run by a private organization. I just received word that even the ILODEP clinic closed, just as all of the other private clinics. The private clinics will not accept cholera patients. Since I last wrote you yesterday, the La SOurce Chaude clinic received 63 patients - because all of the other clinics in the entire commune closed except for the City of Anse Rouge clinic which has no materials. Since the La SOurce Chaude clinic also had no materials, our coordinator Hebert Pierre worked with the Ministry of Health to try to find transport to Gonaives for all 63 of the patients. Gonaives is a treacherous two hour drive from La Source Chaude, and not many vehicles make the voyage. I will fill out the information on the sheet that you sent me just as soon as I am off the call with my board. Thanks for your help! ------------------------------------------- 11/21/10 Have requested Assesment information from Amber for clinic. lpar ------------------------------------------- Email from Amber Munger of Article 29 Organization 11/21/10 Commune Anse Rouge has approximately 37,000 residents but also services parts of Terre Neuve, raising the number to about 42,000. Article 29 Organization's base is in Second Section Commune Anse Rouge, which has four physical health clinics. One is the ILODEP clinic sponsored by Parole et Action, the other three are community clinics which have no paid staff and have not received supplies since July, the last time that A29 secured supplies for distribution to the clinics. There is no doctor or nurse in second section Commune Anse Rouge. There is rumored to be a doctor present in the City of Anse Rouge at the tent clinic (in first section Commune Anse Rouge) at the site of the old hospital that burnt down last year. This clinic is between a 2 to 8 hour walk for people in Second Section Commune Anse Rouge and there are virtually no taptaps or cars in the region. Cholera first entered Second Section Commune Anse Rouge about two weeks ago with cases coming in from people who had been in Gonaives. In second Section Commune Anse Rouge, we had five cases last week. The La Source Chaude clinic, which is the main clinic for the second section and is run by a volunteer nurse auxillary, closed its doors for fear of cholera. All five cholera victims died. A29's coordinator lobbied regional MSPP to re-open the clinic, which the volunteer nurse auxillary has now done, but there are currently no supplies (IV's, hydration fluids, antibiotics) to treat patients. Thus, more patients have arrived at the clinic, receive a cholera diagnosis, and then die. By the time the patients arrive at the clinic they have been too far along to respond to ORS, so IVs are needed. There are very few cars in the region so it is difficult to get patients to the City of Anse Rouge clinic, which as of yesterday was also out of IVs and rehydration fluids. As of yesterday, at least five more cholera patients found transport from SEcond Section Commune Anse Rouge to the City of Anse Rouge clinic in the first section. Two more died at the La Source Chaude clinic in Second Section. Five new patients had arrived at the La Source Clinic yesterday. A29 launched a public education and prevention campaign two weeks ago at teh regions two largest public markets (the City of Anse Rouge and the La Source Chaude markets). Information is spread by megaphone regarding prevention of cholera, treatment and how and when to make ORS. As a result of the outbreak in Gonaives, people are afraid to go to Gonaives for fear of contracting cholera. This puts the entire region in a precarious position as most of the region's supplies are procured in Gonaives (rice, oil, gas, everything). Commune Anse Rouge produces shallot and sourghum and pwa congo but no other crops in sufficient quantity to meet people's basic dietary needs - everything comes from Gonaives. There have been reports that one of the first two cholera victims in the region, when being shut out by the clinic and the community, deliberately polluted the drinking water source in Kay Felip, causing the other three people (of the initial five people) to contract cholera. There is a lot of panic and fear as a result, which could all easily be assuaged with the presence of a qualified doctor or nurse and some cholera medical supplies. A29 is currently engaged in efforts to secure supplies and transport for cholera treatment from PAP but has met with great challenges thus far. A29 is also attempting to engage medical teams to bring support to the region, which almost never receives such assistance because of its isolated location NW of Gonaives. -> 12/16/10 Post on HEAS from Amber Munger The community health committee reports that the La Source Chaude clinic is being well attended by MSF-France. In the past two weeks, new tents have been added to the clinic property (totaling 3). One is being used as a depot for materials, the other two host patients. MSF has provided beds and other helpful materials for the full operation of the CTU. MSF is also supporting 5 nurses at this clinic which, prior to the outbreak, had no competent medical professionals. Yesterday, when A29's coordinator gathered the report from the committee, there were only 8 patients at the clinic. One patient had died earlier that morning (for a total of 9 patients that day). The village of La Source Chaude is the main market-trading village for the region. This market, which meets twice a week, usually attracting people from far away villages the night before, has no public latrine, creating a public health hazard and threatening the potability of the water. The community has mobilized together for the placement of a latrine near the market and they have dug the initial pit for the latrine. To complete the latrine, funds are needed for materials and masons. A29 seeks an NGO partner for latrine building, or funds so that it can facilitate the construction of the latrine with community leaders. --------------------------------------------------- 12/6/10 Email from Amber Munger Karine from MSF emailed me today and said that ORS/OPS had also sent supplies to the Lagon clinic. I dont know who that is or what supplies. In the meantime, AMURT is reporting that they sent a doctor to La Source Chaude that was there for three days, but I did not hear this from Hebert or MSPP. --------------------------------------- 11/4/10 Email from Dr. Grazia Caleo, PAHO Gonaive I am based in Gonaive for PAHO/OMS. I am following the alert situation in the Haut Artibonite. Regarding the situation in Anse Rouge I contacted MSF France they told me that in Source Chaude they set up a UTC in Anse Rouge a points ORS. Also they regularly provide support and supply. (LPar Note: Amber is contacting MSF to coord. and clarify what their support will be. Supply drop was noted in 12/2/10 entry. Staff support needs to be clarified.) ---------------------------------------------- 12/2/10: From conversation with Amber Market days are twice a week Thurs. and Sat. Missionary Air Sities uses airstrip. We were also able to hook them up with CARE for educational materials! Herbert has a meeting with them set up. ------------------------------------------------- 12/2/10 Email from Amber Munger ...still waiting for verifiable information. The volunteer nurse auxiliary in the La Source Chaude Clinic is refusing to give A29 or the community health committee information on cholera patients because we won't provide him with a salary or other means of compensation. As I mentioned before, the nurse auxiliary is a volunteer that does not have a good relationship with the community but is the only medical personnel that the community has. The Communal Director for MSPP (Dr. Carlo) is meeting with the community health committee, community leadership council, A29, and the nurse auxiliary on Friday to resolve the issue. A29's coordinator, Hebert Pierre, at this point can only verify the number of patients that he has seen at the clinic while he has been present in La Source for the last week. In general, the La Source Chaude clinic has had about 15-19 overnight cholera patients per day for the last five days at the CTC. We can confirm, too, that MSF brought 9 boxes of supplies, (presumably hydration fluid) (this is in addition to a large tent and small amt. of supplies that MSPP dropped off after 63 patients were transported)to the La Source Chaude clinic yesterday. After the meeting on Friday I will be able to give an inventory report on what was given. In terms of the Town of Anse Rouge, as I mentioned before, Hebert said that that clinic is closed. When he went to the clinic again on Tuesday to get information there was only a guardian there who could not provide him with any information. He is hoping to establish more formalised lines of communication today and tomorrow as he meets with CARE - who contacted him yesterday - and MSPP on Friday at the community meeting. ------------------------------------------- 11/22/10 Notes from Amber Hebert has not yet even met with the organization in PAP to know what supplies we will get . That appointment is at 10:00 today. The we still ahve to figure out transport for the supplies. As soon as we receive supplies I will let you know. These supplies will be for the La SOurce Chaude clinic FIRST and anything we can spare we will give to teh CIty Clinic. The City Clinic is on Route National One and patients can more easily find transport to Gonaives from that Center. That is not the case where we are in La SOurce Chaude. We need to have supplies at the La SOurce Chaude clinic because those people will not be able to make it to another location easily. It was a blessing that MSPP had a truck available to send to La Source last time. I dont think our luck wil be the same next time around. Water - the La Source Chaude clinic has water as we have hot springs in la Source Chaude (which means, in French, "hot spring"). The nurse auxillary who works there is highly incompetent and does not use the water filter that was set up for the clinic because he does not like the person who installed it. If he decided to use it again it has to be reinstalled and will be at least a few weeks before it is up and running. So we need aquatab or other water disinfectant for the clinic (as well as for the population in general). ---------------------------------------------- 11/21/10 Update on Assessment from Amber Munger When did cholera patients begin to come at this location? 9 or 10 November How many people does your facility serve? There are approximately 37,000 people in Commune Anse Rouge. Normally, the La SOurce Chaude clinic services about 1/6 of the population. Now that all other clinics except the one in the City of Anse Rouge have closed, people are coming from throughout the commune to the La Source Chaude clinic. Current Cholera Patient Load Up until November 18th there were only five cases (all of whom died). However, yesterday 63 patients walked or were transported to the La Source Chaude clinic many of them walking from extremely remote locations where they were expected to have brought cholera from Port-de-Paix. Most of the patients were coming from Tante, Yaya and Bonsinye, extremely high mountain regions that border third section Port-de-Paix. Fatality Rate for Cholera? Five of the five patients who had cholera until November 18th died; one is suspected of intentionally polluting the water source when he was shut out of the clinics, spreading cholera to three other people in the village of Kay Felip. Yesterday, November 20th one patient died and then 63 more people proceeded arrive at teh clinic. These people were transported in a MSPP truck to Gonaives. No one died en route but we are unclear as to what happened after they were deposited in Gonaives. Has number of patients stabilized? Today there were only seven patients in total. Yesterday was market day and people came from very far to the La Source market, explaining the huge increase in numbers. Medical Staffing (eg. no. of Doctors, no. of Nurses, no. of non medical staff): The community health clinic has no paid staff. There is only a volunteer nurse auxillary at the clinic. There are no qualified medical proffessionals (doctors or nurses) in the entire second section Commune Anse Rouge and only one that we know of in the first section. How many patients are you treating daily? Will update in a few days. How many hospitalized? Just transported all patients Does your facility provide Mobile Medical Clinics to the community?we do not have transportation available What is your Cholera Bed Capacity? There were only five beds in the La SOurce clinic. MSPP sent a tent for the clinic to set up in the lakou but have not provided beds. Describe accessibility to your site (e.g. Passable roads? Helicopter Landing Pad or spot? Airstrip for small planes? Please provide conditions for air landings and GPS coordinates). By road, it is a 2 hour trip from Gonaives (one hour on route national one and another hour on teh road from Letan to La Source Chaude). It is a very difficult road, even by Haiti standards. There is a helicopter landing strip in the City of Anse Rouge, which is a one hour drive from La Source Chaude, but is a much easier drive than the trip from Gonaives. Can you pick up supplies? We can pay local trucks to retrieve the supplies. THe local leaders in the community will offer the use of their large transport vehicles. Medical Supply needs (List by PRIORITY please). cholera related supplies and disinfectants. The clinic is also lacking in basic antibiotics for most other treatable illnesses. ---------------------------------------- 11/21/10 Email from Amber Hi folks - Just a quick update on this. Yesterday 63 patients showed up at the La Sources Chaude clinic after noon because all other clinics in Commune Anse Rouge (except for the one in the City of Anse Rouge) closed their doors to cholera patients. A29 Coordinator lobbied MSPP in Gonaives for help. In response, MSPP sent a truck to La Source Chaude to transport the 63 patients to Gonaives. Our coordinator said there were only a few patients who came to the La Source Clinic this morning before he left for PAP to try to seek medical supplies. MSPP sent us some fluid and IVs as well as a tent to set up a CTC in the lakou of the La Sous Clinic. The supplies will not last long. Hebert is in PAP meeting with Americare to see if they would be willing to give us free antibiotics, fluids, clorox for disinfecting the center, and aquatab. As I mentioned before, there are no qualified medical personnel in second section Commune Anse Rouge, and I am not sure that there are any either in the first section either (other than the regional director, who is helping to coordinate rather than see patients). ----------------------------------------- 11/21/10 Email from Amber I am on a call until 8:00 when I will get back to this but for now I wanted to make clear that A29 does not represent the ILODEP clinic. A29 is trying to find support for the community clinics - not the private clinic run by a private organization. I just received word that even the ILODEP clinic closed, just as all of the other private clinics. The private clinics will not accept cholera patients. Since I last wrote you yesterday, the La SOurce Chaude clinic received 63 patients - because all of the other clinics in the entire commune closed except for the City of Anse Rouge clinic which has no materials. Since the La SOurce Chaude clinic also had no materials, our coordinator Hebert Pierre worked with the Ministry of Health to try to find transport to Gonaives for all 63 of the patients. Gonaives is a treacherous two hour drive from La Source Chaude, and not many vehicles make the voyage. I will fill out the information on the sheet that you sent me just as soon as I am off the call with my board. Thanks for your help! ------------------------------------------- 11/21/10 Have requested Assesment information from Amber for clinic. lpar ------------------------------------------- Email from Amber Munger of Article 29 Organization 11/21/10 Commune Anse Rouge has approximately 37,000 residents but also services parts of Terre Neuve, raising the number to about 42,000. Article 29 Organization's base is in Second Section Commune Anse Rouge, which has four physical health clinics. One is the ILODEP clinic sponsored by Parole et Action, the other three are community clinics which have no paid staff and have not received supplies since July, the last time that A29 secured supplies for distribution to the clinics. There is no doctor or nurse in second section Commune Anse Rouge. There is rumored to be a doctor present in the City of Anse Rouge at the tent clinic (in first section Commune Anse Rouge) at the site of the old hospital that burnt down last year. This clinic is between a 2 to 8 hour walk for people in Second Section Commune Anse Rouge and there are virtually no taptaps or cars in the region. Cholera first entered Second Section Commune Anse Rouge about two weeks ago with cases coming in from people who had been in Gonaives. In second Section Commune Anse Rouge, we had five cases last week. The La Source Chaude clinic, which is the main clinic for the second section and is run by a volunteer nurse auxillary, closed its doors for fear of cholera. All five cholera victims died. A29's coordinator lobbied regional MSPP to re-open the clinic, which the volunteer nurse auxillary has now done, but there are currently no supplies (IV's, hydration fluids, antibiotics) to treat patients. Thus, more patients have arrived at the clinic, receive a cholera diagnosis, and then die. By the time the patients arrive at the clinic they have been too far along to respond to ORS, so IVs are needed. There are very few cars in the region so it is difficult to get patients to the City of Anse Rouge clinic, which as of yesterday was also out of IVs and rehydration fluids. As of yesterday, at least five more cholera patients found transport from SEcond Section Commune Anse Rouge to the City of Anse Rouge clinic in the first section. Two more died at the La Source Chaude clinic in Second Section. Five new patients had arrived at the La Source Clinic yesterday. A29 launched a public education and prevention campaign two weeks ago at teh regions two largest public markets (the City of Anse Rouge and the La Source Chaude markets). Information is spread by megaphone regarding prevention of cholera, treatment and how and when to make ORS. As a result of the outbreak in Gonaives, people are afraid to go to Gonaives for fear of contracting cholera. This puts the entire region in a precarious position as most of the region's supplies are procured in Gonaives (rice, oil, gas, everything). Commune Anse Rouge produces shallot and sourghum and pwa congo but no other crops in sufficient quantity to meet people's basic dietary needs - everything comes from Gonaives. There have been reports that one of the first two cholera victims in the region, when being shut out by the clinic and the community, deliberately polluted the drinking water source in Kay Felip, causing the other three people (of the initial five people) to contract cholera. There is a lot of panic and fear as a result, which could all easily be assuaged with the presence of a qualified doctor or nurse and some cholera medical supplies. A29 is currently engaged in efforts to secure supplies and transport for cholera treatment from PAP but has met with great challenges thus far. A29 is also attempting to engage medical teams to bring support to the region, which almost never receives such assistance because of its isolated location NW of Gonaives.

notes: 12/6/10 Email from Amber Munger Karine from MSF emailed me today and said that ORS/OPS had also sent supplies to the Lagon clinic. I dont know who that is or what supplies. In the meantime, AMURT is reporting that they sent a doctor to La Source Chaude that was there for three days, but I did not hear this from Hebert or MSPP. --------------------------------------- 11/4/10 Email from Dr. Grazia Caleo, PAHO Gonaive I am based in Gonaive for PAHO/OMS. I am following the alert situation in the Haut Artibonite. Regarding the situation in Anse Rouge I contacted MSF France they told me that in Source Chaude they set up a UTC in Anse Rouge a points ORS. Also they regularly provide support and supply. (LPar Note: Amber is contacting MSF to coord. and clarify what their support will be. Supply drop was noted in 12/2/10 entry. Staff support needs to be clarified.) ---------------------------------------------- 12/2/10: From conversation with Amber Market days are twice a week Thurs. and Sat. Missionary Air Sities uses airstrip. We were also able to hook them up with CARE for educational materials! Herbert has a meeting with them set up. ------------------------------------------------- 12/2/10 Email from Amber Munger ...still waiting for verifiable information. The volunteer nurse auxiliary in the La Source Chaude Clinic is refusing to give A29 or the community health committee information on cholera patients because we won't provide him with a salary or other means of compensation. As I mentioned before, the nurse auxiliary is a volunteer that does not have a good relationship with the community but is the only medical personnel that the community has. The Communal Director for MSPP (Dr. Carlo) is meeting with the community health committee, community leadership council, A29, and the nurse auxiliary on Friday to resolve the issue. A29's coordinator, Hebert Pierre, at this point can only verify the number of patients that he has seen at the clinic while he has been present in La Source for the last week. In general, the La Source Chaude clinic has had about 15-19 overnight cholera patients per day for the last five days at the CTC. We can confirm, too, that MSF brought 9 boxes of supplies, (presumably hydration fluid) (this is in addition to a large tent and small amt. of supplies that MSPP dropped off after 63 patients were transported)to the La Source Chaude clinic yesterday. After the meeting on Friday I will be able to give an inventory report on what was given. In terms of the Town of Anse Rouge, as I mentioned before, Hebert said that that clinic is closed. When he went to the clinic again on Tuesday to get information there was only a guardian there who could not provide him with any information. He is hoping to establish more formalised lines of communication today and tomorrow as he meets with CARE - who contacted him yesterday - and MSPP on Friday at the community meeting. ------------------------------------------- 11/22/10 Notes from Amber Hebert has not yet even met with the organization in PAP to know what supplies we will get . That appointment is at 10:00 today. The we still ahve to figure out transport for the supplies. As soon as we receive supplies I will let you know. These supplies will be for the La SOurce Chaude clinic FIRST and anything we can spare we will give to teh CIty Clinic. The City Clinic is on Route National One and patients can more easily find transport to Gonaives from that Center. That is not the case where we are in La SOurce Chaude. We need to have supplies at the La SOurce Chaude clinic because those people will not be able to make it to another location easily. It was a blessing that MSPP had a truck available to send to La Source last time. I dont think our luck wil be the same next time around. Water - the La Source Chaude clinic has water as we have hot springs in la Source Chaude (which means, in French, "hot spring"). The nurse auxillary who works there is highly incompetent and does not use the water filter that was set up for the clinic because he does not like the person who installed it. If he decided to use it again it has to be reinstalled and will be at least a few weeks before it is up and running. So we need aquatab or other water disinfectant for the clinic (as well as for the population in general). ---------------------------------------------- 11/21/10 Update on Assessment from Amber Munger When did cholera patients begin to come at this location? 9 or 10 November How many people does your facility serve? There are approximately 37,000 people in Commune Anse Rouge. Normally, the La SOurce Chaude clinic services about 1/6 of the population. Now that all other clinics except the one in the City of Anse Rouge have closed, people are coming from throughout the commune to the La Source Chaude clinic. Current Cholera Patient Load Up until November 18th there were only five cases (all of whom died). However, yesterday 63 patients walked or were transported to the La Source Chaude clinic many of them walking from extremely remote locations where they were expected to have brought cholera from Port-de-Paix. Most of the patients were coming from Tante, Yaya and Bonsinye, extremely high mountain regions that border third section Port-de-Paix. Fatality Rate for Cholera? Five of the five patients who had cholera until November 18th died; one is suspected of intentionally polluting the water source when he was shut out of the clinics, spreading cholera to three other people in the village of Kay Felip. Yesterday, November 20th one patient died and then 63 more people proceeded arrive at teh clinic. These people were transported in a MSPP truck to Gonaives. No one died en route but we are unclear as to what happened after they were deposited in Gonaives. Has number of patients stabilized? Today there were only seven patients in total. Yesterday was market day and people came from very far to the La Source market, explaining the huge increase in numbers. Medical Staffing (eg. no. of Doctors, no. of Nurses, no. of non medical staff): The community health clinic has no paid staff. There is only a volunteer nurse auxillary at the clinic. There are no qualified medical proffessionals (doctors or nurses) in the entire second section Commune Anse Rouge and only one that we know of in the first section. How many patients are you treating daily? Will update in a few days. How many hospitalized? Just transported all patients Does your facility provide Mobile Medical Clinics to the community?we do not have transportation available What is your Cholera Bed Capacity? There were only five beds in the La SOurce clinic. MSPP sent a tent for the clinic to set up in the lakou but have not provided beds. Describe accessibility to your site (e.g. Passable roads? Helicopter Landing Pad or spot? Airstrip for small planes? Please provide conditions for air landings and GPS coordinates). By road, it is a 2 hour trip from Gonaives (one hour on route national one and another hour on teh road from Letan to La Source Chaude). It is a very difficult road, even by Haiti standards. There is a helicopter landing strip in the City of Anse Rouge, which is a one hour drive from La Source Chaude, but is a much easier drive than the trip from Gonaives. Can you pick up supplies? We can pay local trucks to retrieve the supplies. THe local leaders in the community will offer the use of their large transport vehicles. Medical Supply needs (List by PRIORITY please). cholera related supplies and disinfectants. The clinic is also lacking in basic antibiotics for most other treatable illnesses. ---------------------------------------- 11/21/10 Email from Amber Hi folks - Just a quick update on this. Yesterday 63 patients showed up at the La Sources Chaude clinic after noon because all other clinics in Commune Anse Rouge (except for the one in the City of Anse Rouge) closed their doors to cholera patients. A29 Coordinator lobbied MSPP in Gonaives for help. In response, MSPP sent a truck to La Source Chaude to transport the 63 patients to Gonaives. Our coordinator said there were only a few patients who came to the La Source Clinic this morning before he left for PAP to try to seek medical supplies. MSPP sent us some fluid and IVs as well as a tent to set up a CTC in the lakou of the La Sous Clinic. The supplies will not last long. Hebert is in PAP meeting with Americare to see if they would be willing to give us free antibiotics, fluids, clorox for disinfecting the center, and aquatab. As I mentioned before, there are no qualified medical personnel in second section Commune Anse Rouge, and I am not sure that there are any either in the first section either (other than the regional director, who is helping to coordinate rather than see patients). ----------------------------------------- 11/21/10 Email from Amber I am on a call until 8:00 when I will get back to this but for now I wanted to make clear that A29 does not represent the ILODEP clinic. A29 is trying to find support for the community clinics - not the private clinic run by a private organization. I just received word that even the ILODEP clinic closed, just as all of the other private clinics. The private clinics will not accept cholera patients. Since I last wrote you yesterday, the La SOurce Chaude clinic received 63 patients - because all of the other clinics in the entire commune closed except for the City of Anse Rouge clinic which has no materials. Since the La SOurce Chaude clinic also had no materials, our coordinator Hebert Pierre worked with the Ministry of Health to try to find transport to Gonaives for all 63 of the patients. Gonaives is a treacherous two hour drive from La Source Chaude, and not many vehicles make the voyage. I will fill out the information on the sheet that you sent me just as soon as I am off the call with my board. Thanks for your help! ------------------------------------------- 11/21/10 Have requested Assesment information from Amber for clinic. lpar ------------------------------------------- Email from Amber Munger of Article 29 Organization 11/21/10 Commune Anse Rouge has approximately 37,000 residents but also services parts of Terre Neuve, raising the number to about 42,000. Article 29 Organization's base is in Second Section Commune Anse Rouge, which has four physical health clinics. One is the ILODEP clinic sponsored by Parole et Action, the other three are community clinics which have no paid staff and have not received supplies since July, the last time that A29 secured supplies for distribution to the clinics. There is no doctor or nurse in second section Commune Anse Rouge. There is rumored to be a doctor present in the City of Anse Rouge at the tent clinic (in first section Commune Anse Rouge) at the site of the old hospital that burnt down last year. This clinic is between a 2 to 8 hour walk for people in Second Section Commune Anse Rouge and there are virtually no taptaps or cars in the region. Cholera first entered Second Section Commune Anse Rouge about two weeks ago with cases coming in from people who had been in Gonaives. In second Section Commune Anse Rouge, we had five cases last week. The La Source Chaude clinic, which is the main clinic for the second section and is run by a volunteer nurse auxillary, closed its doors for fear of cholera. All five cholera victims died. A29's coordinator lobbied regional MSPP to re-open the clinic, which the volunteer nurse auxillary has now done, but there are currently no supplies (IV's, hydration fluids, antibiotics) to treat patients. Thus, more patients have arrived at the clinic, receive a cholera diagnosis, and then die. By the time the patients arrive at the clinic they have been too far along to respond to ORS, so IVs are needed. There are very few cars in the region so it is difficult to get patients to the City of Anse Rouge clinic, which as of yesterday was also out of IVs and rehydration fluids. As of yesterday, at least five more cholera patients found transport from SEcond Section Commune Anse Rouge to the City of Anse Rouge clinic in the first section. Two more died at the La Source Chaude clinic in Second Section. Five new patients had arrived at the La Source Clinic yesterday. A29 launched a public education and prevention campaign two weeks ago at teh regions two largest public markets (the City of Anse Rouge and the La Source Chaude markets). Information is spread by megaphone regarding prevention of cholera, treatment and how and when to make ORS. As a result of the outbreak in Gonaives, people are afraid to go to Gonaives for fear of contracting cholera. This puts the entire region in a precarious position as most of the region's supplies are procured in Gonaives (rice, oil, gas, everything). Commune Anse Rouge produces shallot and sourghum and pwa congo but no other crops in sufficient quantity to meet people's basic dietary needs - everything comes from Gonaives. There have been reports that one of the first two cholera victims in the region, when being shut out by the clinic and the community, deliberately polluted the drinking water source in Kay Felip, causing the other three people (of the initial five people) to contract cholera. There is a lot of panic and fear as a result, which could all easily be assuaged with the presence of a qualified doctor or nurse and some cholera medical supplies. A29 is currently engaged in efforts to secure supplies and transport for cholera treatment from PAP but has met with great challenges thus far. A29 is also attempting to engage medical teams to bring support to the region, which almost never receives such assistance because of its isolated location NW of Gonaives. -> 12/16/10 Post on HEAS from Amber Munger The community health committee reports that the La Source Chaude clinic is being well attended by MSF-France. In the past two weeks, new tents have been added to the clinic property (totaling 3). One is being used as a depot for materials, the other two host patients. MSF has provided beds and other helpful materials for the full operation of the CTU. MSF is also supporting 5 nurses at this clinic which, prior to the outbreak, had no competent medical professionals. Yesterday, when A29's coordinator gathered the report from the committee, there were only 8 patients at the clinic. One patient had died earlier that morning (for a total of 9 patients that day). --------------------------------------------------- 12/6/10 Email from Amber Munger Karine from MSF emailed me today and said that ORS/OPS had also sent supplies to the Lagon clinic. I dont know who that is or what supplies. In the meantime, AMURT is reporting that they sent a doctor to La Source Chaude that was there for three days, but I did not hear this from Hebert or MSPP. --------------------------------------- 11/4/10 Email from Dr. Grazia Caleo, PAHO Gonaive I am based in Gonaive for PAHO/OMS. I am following the alert situation in the Haut Artibonite. Regarding the situation in Anse Rouge I contacted MSF France they told me that in Source Chaude they set up a UTC in Anse Rouge a points ORS. Also they regularly provide support and supply. (LPar Note: Amber is contacting MSF to coord. and clarify what their support will be. Supply drop was noted in 12/2/10 entry. Staff support needs to be clarified.) ---------------------------------------------- 12/2/10: From conversation with Amber Market days are twice a week Thurs. and Sat. Missionary Air Sities uses airstrip. We were also able to hook them up with CARE for educational materials! Herbert has a meeting with them set up. ------------------------------------------------- 12/2/10 Email from Amber Munger ...still waiting for verifiable information. The volunteer nurse auxiliary in the La Source Chaude Clinic is refusing to give A29 or the community health committee information on cholera patients because we won't provide him with a salary or other means of compensation. As I mentioned before, the nurse auxiliary is a volunteer that does not have a good relationship with the community but is the only medical personnel that the community has. The Communal Director for MSPP (Dr. Carlo) is meeting with the community health committee, community leadership council, A29, and the nurse auxiliary on Friday to resolve the issue. A29's coordinator, Hebert Pierre, at this point can only verify the number of patients that he has seen at the clinic while he has been present in La Source for the last week. In general, the La Source Chaude clinic has had about 15-19 overnight cholera patients per day for the last five days at the CTC. We can confirm, too, that MSF brought 9 boxes of supplies, (presumably hydration fluid) (this is in addition to a large tent and small amt. of supplies that MSPP dropped off after 63 patients were transported)to the La Source Chaude clinic yesterday. After the meeting on Friday I will be able to give an inventory report on what was given. In terms of the Town of Anse Rouge, as I mentioned before, Hebert said that that clinic is closed. When he went to the clinic again on Tuesday to get information there was only a guardian there who could not provide him with any information. He is hoping to establish more formalised lines of communication today and tomorrow as he meets with CARE - who contacted him yesterday - and MSPP on Friday at the community meeting. ------------------------------------------- 11/22/10 Notes from Amber Hebert has not yet even met with the organization in PAP to know what supplies we will get . That appointment is at 10:00 today. The we still ahve to figure out transport for the supplies. As soon as we receive supplies I will let you know. These supplies will be for the La SOurce Chaude clinic FIRST and anything we can spare we will give to teh CIty Clinic. The City Clinic is on Route National One and patients can more easily find transport to Gonaives from that Center. That is not the case where we are in La SOurce Chaude. We need to have supplies at the La SOurce Chaude clinic because those people will not be able to make it to another location easily. It was a blessing that MSPP had a truck available to send to La Source last time. I dont think our luck wil be the same next time around. Water - the La Source Chaude clinic has water as we have hot springs in la Source Chaude (which means, in French, "hot spring"). The nurse auxillary who works there is highly incompetent and does not use the water filter that was set up for the clinic because he does not like the person who installed it. If he decided to use it again it has to be reinstalled and will be at least a few weeks before it is up and running. So we need aquatab or other water disinfectant for the clinic (as well as for the population in general). ---------------------------------------------- 11/21/10 Update on Assessment from Amber Munger When did cholera patients begin to come at this location? 9 or 10 November How many people does your facility serve? There are approximately 37,000 people in Commune Anse Rouge. Normally, the La SOurce Chaude clinic services about 1/6 of the population. Now that all other clinics except the one in the City of Anse Rouge have closed, people are coming from throughout the commune to the La Source Chaude clinic. Current Cholera Patient Load Up until November 18th there were only five cases (all of whom died). However, yesterday 63 patients walked or were transported to the La Source Chaude clinic many of them walking from extremely remote locations where they were expected to have brought cholera from Port-de-Paix. Most of the patients were coming from Tante, Yaya and Bonsinye, extremely high mountain regions that border third section Port-de-Paix. Fatality Rate for Cholera? Five of the five patients who had cholera until November 18th died; one is suspected of intentionally polluting the water source when he was shut out of the clinics, spreading cholera to three other people in the village of Kay Felip. Yesterday, November 20th one patient died and then 63 more people proceeded arrive at teh clinic. These people were transported in a MSPP truck to Gonaives. No one died en route but we are unclear as to what happened after they were deposited in Gonaives. Has number of patients stabilized? Today there were only seven patients in total. Yesterday was market day and people came from very far to the La Source market, explaining the huge increase in numbers. Medical Staffing (eg. no. of Doctors, no. of Nurses, no. of non medical staff): The community health clinic has no paid staff. There is only a volunteer nurse auxillary at the clinic. There are no qualified medical proffessionals (doctors or nurses) in the entire second section Commune Anse Rouge and only one that we know of in the first section. How many patients are you treating daily? Will update in a few days. How many hospitalized? Just transported all patients Does your facility provide Mobile Medical Clinics to the community?we do not have transportation available What is your Cholera Bed Capacity? There were only five beds in the La SOurce clinic. MSPP sent a tent for the clinic to set up in the lakou but have not provided beds. Describe accessibility to your site (e.g. Passable roads? Helicopter Landing Pad or spot? Airstrip for small planes? Please provide conditions for air landings and GPS coordinates). By road, it is a 2 hour trip from Gonaives (one hour on route national one and another hour on teh road from Letan to La Source Chaude). It is a very difficult road, even by Haiti standards. There is a helicopter landing strip in the City of Anse Rouge, which is a one hour drive from La Source Chaude, but is a much easier drive than the trip from Gonaives. Can you pick up supplies? We can pay local trucks to retrieve the supplies. THe local leaders in the community will offer the use of their large transport vehicles. Medical Supply needs (List by PRIORITY please). cholera related supplies and disinfectants. The clinic is also lacking in basic antibiotics for most other treatable illnesses. ---------------------------------------- 11/21/10 Email from Amber Hi folks - Just a quick update on this. Yesterday 63 patients showed up at the La Sources Chaude clinic after noon because all other clinics in Commune Anse Rouge (except for the one in the City of Anse Rouge) closed their doors to cholera patients. A29 Coordinator lobbied MSPP in Gonaives for help. In response, MSPP sent a truck to La Source Chaude to transport the 63 patients to Gonaives. Our coordinator said there were only a few patients who came to the La Source Clinic this morning before he left for PAP to try to seek medical supplies. MSPP sent us some fluid and IVs as well as a tent to set up a CTC in the lakou of the La Sous Clinic. The supplies will not last long. Hebert is in PAP meeting with Americare to see if they would be willing to give us free antibiotics, fluids, clorox for disinfecting the center, and aquatab. As I mentioned before, there are no qualified medical personnel in second section Commune Anse Rouge, and I am not sure that there are any either in the first section either (other than the regional director, who is helping to coordinate rather than see patients). ----------------------------------------- 11/21/10 Email from Amber I am on a call until 8:00 when I will get back to this but for now I wanted to make clear that A29 does not represent the ILODEP clinic. A29 is trying to find support for the community clinics - not the private clinic run by a private organization. I just received word that even the ILODEP clinic closed, just as all of the other private clinics. The private clinics will not accept cholera patients. Since I last wrote you yesterday, the La SOurce Chaude clinic received 63 patients - because all of the other clinics in the entire commune closed except for the City of Anse Rouge clinic which has no materials. Since the La SOurce Chaude clinic also had no materials, our coordinator Hebert Pierre worked with the Ministry of Health to try to find transport to Gonaives for all 63 of the patients. Gonaives is a treacherous two hour drive from La Source Chaude, and not many vehicles make the voyage. I will fill out the information on the sheet that you sent me just as soon as I am off the call with my board. Thanks for your help! ------------------------------------------- 11/21/10 Have requested Assesment information from Amber for clinic. lpar ------------------------------------------- Email from Amber Munger of Article 29 Organization 11/21/10 Commune Anse Rouge has approximately 37,000 residents but also services parts of Terre Neuve, raising the number to about 42,000. Article 29 Organization's base is in Second Section Commune Anse Rouge, which has four physical health clinics. One is the ILODEP clinic sponsored by Parole et Action, the other three are community clinics which have no paid staff and have not received supplies since July, the last time that A29 secured supplies for distribution to the clinics. There is no doctor or nurse in second section Commune Anse Rouge. There is rumored to be a doctor present in the City of Anse Rouge at the tent clinic (in first section Commune Anse Rouge) at the site of the old hospital that burnt down last year. This clinic is between a 2 to 8 hour walk for people in Second Section Commune Anse Rouge and there are virtually no taptaps or cars in the region. Cholera first entered Second Section Commune Anse Rouge about two weeks ago with cases coming in from people who had been in Gonaives. In second Section Commune Anse Rouge, we had five cases last week. The La Source Chaude clinic, which is the main clinic for the second section and is run by a volunteer nurse auxillary, closed its doors for fear of cholera. All five cholera victims died. A29's coordinator lobbied regional MSPP to re-open the clinic, which the volunteer nurse auxillary has now done, but there are currently no supplies (IV's, hydration fluids, antibiotics) to treat patients. Thus, more patients have arrived at the clinic, receive a cholera diagnosis, and then die. By the time the patients arrive at the clinic they have been too far along to respond to ORS, so IVs are needed. There are very few cars in the region so it is difficult to get patients to the City of Anse Rouge clinic, which as of yesterday was also out of IVs and rehydration fluids. As of yesterday, at least five more cholera patients found transport from SEcond Section Commune Anse Rouge to the City of Anse Rouge clinic in the first section. Two more died at the La Source Chaude clinic in Second Section. Five new patients had arrived at the La Source Clinic yesterday. A29 launched a public education and prevention campaign two weeks ago at teh regions two largest public markets (the City of Anse Rouge and the La Source Chaude markets). Information is spread by megaphone regarding prevention of cholera, treatment and how and when to make ORS. As a result of the outbreak in Gonaives, people are afraid to go to Gonaives for fear of contracting cholera. This puts the entire region in a precarious position as most of the region's supplies are procured in Gonaives (rice, oil, gas, everything). Commune Anse Rouge produces shallot and sourghum and pwa congo but no other crops in sufficient quantity to meet people's basic dietary needs - everything comes from Gonaives. There have been reports that one of the first two cholera victims in the region, when being shut out by the clinic and the community, deliberately polluted the drinking water source in Kay Felip, causing the other three people (of the initial five people) to contract cholera. There is a lot of panic and fear as a result, which could all easily be assuaged with the presence of a qualified doctor or nurse and some cholera medical supplies. A29 is currently engaged in efforts to secure supplies and transport for cholera treatment from PAP but has met with great challenges thus far. A29 is also attempting to engage medical teams to bring support to the region, which almost never receives such assistance because of its isolated location NW of Gonaives.

notes: 12/6/10 Email from Amber Munger PIH was responding to the watchboard. It would have been much more helpful if PAHO would have informed everyone that they intended to respond to the watchboard by visiting the site and sending supplies rather than reporting back the day after they visited. They obviously planned the visit the day before they went, meaning that about 48 hours passed between the time that they decided to go and the time that they reported with us. During that time JHPRO, PIH and others made plans to go that would have been a wasteful use of resources had we not caught them. Karine from MSF emailed me today and said that ORS/OPS had also sent supplies to the Lagon clinic. I dont know who that is or what supplies. In the meantime, AMURT is reporting that they sent a doctor to La Source Chaude that was there for three days, but I did not hear this from Hebert or MSPP. --------------------------------------- 11/4/10 Email from Dr. Grazia Caleo, PAHO Gonaive I am based in Gonaive for PAHO/OMS. I am following the alert situation in the Haut Artibonite. Regarding the situation in Anse Rouge I contacted MSF France they told me that in Source Chaude they set up a UTC in Anse Rouge a points ORS. Also they regularly provide support and supply. (LPar Note: Amber is contacting MSF to coord. and clarify what their support will be. Supply drop was noted in 12/2/10 entry. Staff support needs to be clarified.) ---------------------------------------------- 12/2/10: From conversation with Amber Market days are twice a week Thurs. and Sat. Missionary Air Sities uses airstrip. We were also able to hook them up with CARE for educational materials! Herbert has a meeting with them set up. ------------------------------------------------- 12/2/10 Email from Amber Munger ...still waiting for verifiable information. The volunteer nurse auxiliary in the La Source Chaude Clinic is refusing to give A29 or the community health committee information on cholera patients because we won't provide him with a salary or other means of compensation. As I mentioned before, the nurse auxiliary is a volunteer that does not have a good relationship with the community but is the only medical personnel that the community has. The Communal Director for MSPP (Dr. Carlo) is meeting with the community health committee, community leadership council, A29, and the nurse auxiliary on Friday to resolve the issue. A29's coordinator, Hebert Pierre, at this point can only verify the number of patients that he has seen at the clinic while he has been present in La Source for the last week. In general, the La Source Chaude clinic has had about 15-19 overnight cholera patients per day for the last five days at the CTC. We can confirm, too, that MSF brought 9 boxes of supplies, (presumably hydration fluid) (this is in addition to a large tent and small amt. of supplies that MSPP dropped off after 63 patients were transported)to the La Source Chaude clinic yesterday. After the meeting on Friday I will be able to give an inventory report on what was given. In terms of the Town of Anse Rouge, as I mentioned before, Hebert said that that clinic is closed. When he went to the clinic again on Tuesday to get information there was only a guardian there who could not provide him with any information. He is hoping to establish more formalised lines of communication today and tomorrow as he meets with CARE - who contacted him yesterday - and MSPP on Friday at the community meeting. ------------------------------------------- 11/22/10 Notes from Amber Hebert has not yet even met with the organization in PAP to know what supplies we will get . That appointment is at 10:00 today. The we still ahve to figure out transport for the supplies. As soon as we receive supplies I will let you know. These supplies will be for the La SOurce Chaude clinic FIRST and anything we can spare we will give to teh CIty Clinic. The City Clinic is on Route National One and patients can more easily find transport to Gonaives from that Center. That is not the case where we are in La SOurce Chaude. We need to have supplies at the La SOurce Chaude clinic because those people will not be able to make it to another location easily. It was a blessing that MSPP had a truck available to send to La Source last time. I dont think our luck wil be the same next time around. Water - the La Source Chaude clinic has water as we have hot springs in la Source Chaude (which means, in French, "hot spring"). The nurse auxillary who works there is highly incompetent and does not use the water filter that was set up for the clinic because he does not like the person who installed it. If he decided to use it again it has to be reinstalled and will be at least a few weeks before it is up and running. So we need aquatab or other water disinfectant for the clinic (as well as for the population in general). ---------------------------------------------- 11/21/10 Update on Assessment from Amber Munger When did cholera patients begin to come at this location? 9 or 10 November How many people does your facility serve? There are approximately 37,000 people in Commune Anse Rouge. Normally, the La SOurce Chaude clinic services about 1/6 of the population. Now that all other clinics except the one in the City of Anse Rouge have closed, people are coming from throughout the commune to the La Source Chaude clinic. Current Cholera Patient Load Up until November 18th there were only five cases (all of whom died). However, yesterday 63 patients walked or were transported to the La Source Chaude clinic many of them walking from extremely remote locations where they were expected to have brought cholera from Port-de-Paix. Most of the patients were coming from Tante, Yaya and Bonsinye, extremely high mountain regions that border third section Port-de-Paix. Fatality Rate for Cholera? Five of the five patients who had cholera until November 18th died; one is suspected of intentionally polluting the water source when he was shut out of the clinics, spreading cholera to three other people in the village of Kay Felip. Yesterday, November 20th one patient died and then 63 more people proceeded arrive at teh clinic. These people were transported in a MSPP truck to Gonaives. No one died en route but we are unclear as to what happened after they were deposited in Gonaives. Has number of patients stabilized? Today there were only seven patients in total. Yesterday was market day and people came from very far to the La Source market, explaining the huge increase in numbers. Medical Staffing (eg. no. of Doctors, no. of Nurses, no. of non medical staff): The community health clinic has no paid staff. There is only a volunteer nurse auxillary at the clinic. There are no qualified medical proffessionals (doctors or nurses) in the entire second section Commune Anse Rouge and only one that we know of in the first section. How many patients are you treating daily? Will update in a few days. How many hospitalized? Just transported all patients Does your facility provide Mobile Medical Clinics to the community?we do not have transportation available What is your Cholera Bed Capacity? There were only five beds in the La SOurce clinic. MSPP sent a tent for the clinic to set up in the lakou but have not provided beds. Describe accessibility to your site (e.g. Passable roads? Helicopter Landing Pad or spot? Airstrip for small planes? Please provide conditions for air landings and GPS coordinates). By road, it is a 2 hour trip from Gonaives (one hour on route national one and another hour on teh road from Letan to La Source Chaude). It is a very difficult road, even by Haiti standards. There is a helicopter landing strip in the City of Anse Rouge, which is a one hour drive from La Source Chaude, but is a much easier drive than the trip from Gonaives. Can you pick up supplies? We can pay local trucks to retrieve the supplies. THe local leaders in the community will offer the use of their large transport vehicles. Medical Supply needs (List by PRIORITY please). cholera related supplies and disinfectants. The clinic is also lacking in basic antibiotics for most other treatable illnesses. ---------------------------------------- 11/21/10 Email from Amber Hi folks - Just a quick update on this. Yesterday 63 patients showed up at the La Sources Chaude clinic after noon because all other clinics in Commune Anse Rouge (except for the one in the City of Anse Rouge) closed their doors to cholera patients. A29 Coordinator lobbied MSPP in Gonaives for help. In response, MSPP sent a truck to La Source Chaude to transport the 63 patients to Gonaives. Our coordinator said there were only a few patients who came to the La Source Clinic this morning before he left for PAP to try to seek medical supplies. MSPP sent us some fluid and IVs as well as a tent to set up a CTC in the lakou of the La Sous Clinic. The supplies will not last long. Hebert is in PAP meeting with Americare to see if they would be willing to give us free antibiotics, fluids, clorox for disinfecting the center, and aquatab. As I mentioned before, there are no qualified medical personnel in second section Commune Anse Rouge, and I am not sure that there are any either in the first section either (other than the regional director, who is helping to coordinate rather than see patients). ----------------------------------------- 11/21/10 Email from Amber I am on a call until 8:00 when I will get back to this but for now I wanted to make clear that A29 does not represent the ILODEP clinic. A29 is trying to find support for the community clinics - not the private clinic run by a private organization. I just received word that even the ILODEP clinic closed, just as all of the other private clinics. The private clinics will not accept cholera patients. Since I last wrote you yesterday, the La SOurce Chaude clinic received 63 patients - because all of the other clinics in the entire commune closed except for the City of Anse Rouge clinic which has no materials. Since the La SOurce Chaude clinic also had no materials, our coordinator Hebert Pierre worked with the Ministry of Health to try to find transport to Gonaives for all 63 of the patients. Gonaives is a treacherous two hour drive from La Source Chaude, and not many vehicles make the voyage. I will fill out the information on the sheet that you sent me just as soon as I am off the call with my board. Thanks for your help! ------------------------------------------- 11/21/10 Have requested Assesment information from Amber for clinic. lpar ------------------------------------------- Email from Amber Munger of Article 29 Organization 11/21/10 Commune Anse Rouge has approximately 37,000 residents but also services parts of Terre Neuve, raising the number to about 42,000. Article 29 Organization's base is in Second Section Commune Anse Rouge, which has four physical health clinics. One is the ILODEP clinic sponsored by Parole et Action, the other three are community clinics which have no paid staff and have not received supplies since July, the last time that A29 secured supplies for distribution to the clinics. There is no doctor or nurse in second section Commune Anse Rouge. There is rumored to be a doctor present in the City of Anse Rouge at the tent clinic (in first section Commune Anse Rouge) at the site of the old hospital that burnt down last year. This clinic is between a 2 to 8 hour walk for people in Second Section Commune Anse Rouge and there are virtually no taptaps or cars in the region. Cholera first entered Second Section Commune Anse Rouge about two weeks ago with cases coming in from people who had been in Gonaives. In second Section Commune Anse Rouge, we had five cases last week. The La Source Chaude clinic, which is the main clinic for the second section and is run by a volunteer nurse auxillary, closed its doors for fear of cholera. All five cholera victims died. A29's coordinator lobbied regional MSPP to re-open the clinic, which the volunteer nurse auxillary has now done, but there are currently no supplies (IV's, hydration fluids, antibiotics) to treat patients. Thus, more patients have arrived at the clinic, receive a cholera diagnosis, and then die. By the time the patients arrive at the clinic they have been too far along to respond to ORS, so IVs are needed. There are very few cars in the region so it is difficult to get patients to the City of Anse Rouge clinic, which as of yesterday was also out of IVs and rehydration fluids. As of yesterday, at least five more cholera patients found transport from SEcond Section Commune Anse Rouge to the City of Anse Rouge clinic in the first section. Two more died at the La Source Chaude clinic in Second Section. Five new patients had arrived at the La Source Clinic yesterday. A29 launched a public education and prevention campaign two weeks ago at teh regions two largest public markets (the City of Anse Rouge and the La Source Chaude markets). Information is spread by megaphone regarding prevention of cholera, treatment and how and when to make ORS. As a result of the outbreak in Gonaives, people are afraid to go to Gonaives for fear of contracting cholera. This puts the entire region in a precarious position as most of the region's supplies are procured in Gonaives (rice, oil, gas, everything). Commune Anse Rouge produces shallot and sourghum and pwa congo but no other crops in sufficient quantity to meet people's basic dietary needs - everything comes from Gonaives. There have been reports that one of the first two cholera victims in the region, when being shut out by the clinic and the community, deliberately polluted the drinking water source in Kay Felip, causing the other three people (of the initial five people) to contract cholera. There is a lot of panic and fear as a result, which could all easily be assuaged with the presence of a qualified doctor or nurse and some cholera medical supplies. A29 is currently engaged in efforts to secure supplies and transport for cholera treatment from PAP but has met with great challenges thus far. A29 is also attempting to engage medical teams to bring support to the region, which almost never receives such assistance because of its isolated location NW of Gonaives. -> 12/6/10 Email from Amber Munger Karine from MSF emailed me today and said that ORS/OPS had also sent supplies to the Lagon clinic. I dont know who that is or what supplies. In the meantime, AMURT is reporting that they sent a doctor to La Source Chaude that was there for three days, but I did not hear this from Hebert or MSPP. --------------------------------------- 11/4/10 Email from Dr. Grazia Caleo, PAHO Gonaive I am based in Gonaive for PAHO/OMS. I am following the alert situation in the Haut Artibonite. Regarding the situation in Anse Rouge I contacted MSF France they told me that in Source Chaude they set up a UTC in Anse Rouge a points ORS. Also they regularly provide support and supply. (LPar Note: Amber is contacting MSF to coord. and clarify what their support will be. Supply drop was noted in 12/2/10 entry. Staff support needs to be clarified.) ---------------------------------------------- 12/2/10: From conversation with Amber Market days are twice a week Thurs. and Sat. Missionary Air Sities uses airstrip. We were also able to hook them up with CARE for educational materials! Herbert has a meeting with them set up. ------------------------------------------------- 12/2/10 Email from Amber Munger ...still waiting for verifiable information. The volunteer nurse auxiliary in the La Source Chaude Clinic is refusing to give A29 or the community health committee information on cholera patients because we won't provide him with a salary or other means of compensation. As I mentioned before, the nurse auxiliary is a volunteer that does not have a good relationship with the community but is the only medical personnel that the community has. The Communal Director for MSPP (Dr. Carlo) is meeting with the community health committee, community leadership council, A29, and the nurse auxiliary on Friday to resolve the issue. A29's coordinator, Hebert Pierre, at this point can only verify the number of patients that he has seen at the clinic while he has been present in La Source for the last week. In general, the La Source Chaude clinic has had about 15-19 overnight cholera patients per day for the last five days at the CTC. We can confirm, too, that MSF brought 9 boxes of supplies, (presumably hydration fluid) (this is in addition to a large tent and small amt. of supplies that MSPP dropped off after 63 patients were transported)to the La Source Chaude clinic yesterday. After the meeting on Friday I will be able to give an inventory report on what was given. In terms of the Town of Anse Rouge, as I mentioned before, Hebert said that that clinic is closed. When he went to the clinic again on Tuesday to get information there was only a guardian there who could not provide him with any information. He is hoping to establish more formalised lines of communication today and tomorrow as he meets with CARE - who contacted him yesterday - and MSPP on Friday at the community meeting. ------------------------------------------- 11/22/10 Notes from Amber Hebert has not yet even met with the organization in PAP to know what supplies we will get . That appointment is at 10:00 today. The we still ahve to figure out transport for the supplies. As soon as we receive supplies I will let you know. These supplies will be for the La SOurce Chaude clinic FIRST and anything we can spare we will give to teh CIty Clinic. The City Clinic is on Route National One and patients can more easily find transport to Gonaives from that Center. That is not the case where we are in La SOurce Chaude. We need to have supplies at the La SOurce Chaude clinic because those people will not be able to make it to another location easily. It was a blessing that MSPP had a truck available to send to La Source last time. I dont think our luck wil be the same next time around. Water - the La Source Chaude clinic has water as we have hot springs in la Source Chaude (which means, in French, "hot spring"). The nurse auxillary who works there is highly incompetent and does not use the water filter that was set up for the clinic because he does not like the person who installed it. If he decided to use it again it has to be reinstalled and will be at least a few weeks before it is up and running. So we need aquatab or other water disinfectant for the clinic (as well as for the population in general). ---------------------------------------------- 11/21/10 Update on Assessment from Amber Munger When did cholera patients begin to come at this location? 9 or 10 November How many people does your facility serve? There are approximately 37,000 people in Commune Anse Rouge. Normally, the La SOurce Chaude clinic services about 1/6 of the population. Now that all other clinics except the one in the City of Anse Rouge have closed, people are coming from throughout the commune to the La Source Chaude clinic. Current Cholera Patient Load Up until November 18th there were only five cases (all of whom died). However, yesterday 63 patients walked or were transported to the La Source Chaude clinic many of them walking from extremely remote locations where they were expected to have brought cholera from Port-de-Paix. Most of the patients were coming from Tante, Yaya and Bonsinye, extremely high mountain regions that border third section Port-de-Paix. Fatality Rate for Cholera? Five of the five patients who had cholera until November 18th died; one is suspected of intentionally polluting the water source when he was shut out of the clinics, spreading cholera to three other people in the village of Kay Felip. Yesterday, November 20th one patient died and then 63 more people proceeded arrive at teh clinic. These people were transported in a MSPP truck to Gonaives. No one died en route but we are unclear as to what happened after they were deposited in Gonaives. Has number of patients stabilized? Today there were only seven patients in total. Yesterday was market day and people came from very far to the La Source market, explaining the huge increase in numbers. Medical Staffing (eg. no. of Doctors, no. of Nurses, no. of non medical staff): The community health clinic has no paid staff. There is only a volunteer nurse auxillary at the clinic. There are no qualified medical proffessionals (doctors or nurses) in the entire second section Commune Anse Rouge and only one that we know of in the first section. How many patients are you treating daily? Will update in a few days. How many hospitalized? Just transported all patients Does your facility provide Mobile Medical Clinics to the community?we do not have transportation available What is your Cholera Bed Capacity? There were only five beds in the La SOurce clinic. MSPP sent a tent for the clinic to set up in the lakou but have not provided beds. Describe accessibility to your site (e.g. Passable roads? Helicopter Landing Pad or spot? Airstrip for small planes? Please provide conditions for air landings and GPS coordinates). By road, it is a 2 hour trip from Gonaives (one hour on route national one and another hour on teh road from Letan to La Source Chaude). It is a very difficult road, even by Haiti standards. There is a helicopter landing strip in the City of Anse Rouge, which is a one hour drive from La Source Chaude, but is a much easier drive than the trip from Gonaives. Can you pick up supplies? We can pay local trucks to retrieve the supplies. THe local leaders in the community will offer the use of their large transport vehicles. Medical Supply needs (List by PRIORITY please). cholera related supplies and disinfectants. The clinic is also lacking in basic antibiotics for most other treatable illnesses. ---------------------------------------- 11/21/10 Email from Amber Hi folks - Just a quick update on this. Yesterday 63 patients showed up at the La Sources Chaude clinic after noon because all other clinics in Commune Anse Rouge (except for the one in the City of Anse Rouge) closed their doors to cholera patients. A29 Coordinator lobbied MSPP in Gonaives for help. In response, MSPP sent a truck to La Source Chaude to transport the 63 patients to Gonaives. Our coordinator said there were only a few patients who came to the La Source Clinic this morning before he left for PAP to try to seek medical supplies. MSPP sent us some fluid and IVs as well as a tent to set up a CTC in the lakou of the La Sous Clinic. The supplies will not last long. Hebert is in PAP meeting with Americare to see if they would be willing to give us free antibiotics, fluids, clorox for disinfecting the center, and aquatab. As I mentioned before, there are no qualified medical personnel in second section Commune Anse Rouge, and I am not sure that there are any either in the first section either (other than the regional director, who is helping to coordinate rather than see patients). ----------------------------------------- 11/21/10 Email from Amber I am on a call until 8:00 when I will get back to this but for now I wanted to make clear that A29 does not represent the ILODEP clinic. A29 is trying to find support for the community clinics - not the private clinic run by a private organization. I just received word that even the ILODEP clinic closed, just as all of the other private clinics. The private clinics will not accept cholera patients. Since I last wrote you yesterday, the La SOurce Chaude clinic received 63 patients - because all of the other clinics in the entire commune closed except for the City of Anse Rouge clinic which has no materials. Since the La SOurce Chaude clinic also had no materials, our coordinator Hebert Pierre worked with the Ministry of Health to try to find transport to Gonaives for all 63 of the patients. Gonaives is a treacherous two hour drive from La Source Chaude, and not many vehicles make the voyage. I will fill out the information on the sheet that you sent me just as soon as I am off the call with my board. Thanks for your help! ------------------------------------------- 11/21/10 Have requested Assesment information from Amber for clinic. lpar ------------------------------------------- Email from Amber Munger of Article 29 Organization 11/21/10 Commune Anse Rouge has approximately 37,000 residents but also services parts of Terre Neuve, raising the number to about 42,000. Article 29 Organization's base is in Second Section Commune Anse Rouge, which has four physical health clinics. One is the ILODEP clinic sponsored by Parole et Action, the other three are community clinics which have no paid staff and have not received supplies since July, the last time that A29 secured supplies for distribution to the clinics. There is no doctor or nurse in second section Commune Anse Rouge. There is rumored to be a doctor present in the City of Anse Rouge at the tent clinic (in first section Commune Anse Rouge) at the site of the old hospital that burnt down last year. This clinic is between a 2 to 8 hour walk for people in Second Section Commune Anse Rouge and there are virtually no taptaps or cars in the region. Cholera first entered Second Section Commune Anse Rouge about two weeks ago with cases coming in from people who had been in Gonaives. In second Section Commune Anse Rouge, we had five cases last week. The La Source Chaude clinic, which is the main clinic for the second section and is run by a volunteer nurse auxillary, closed its doors for fear of cholera. All five cholera victims died. A29's coordinator lobbied regional MSPP to re-open the clinic, which the volunteer nurse auxillary has now done, but there are currently no supplies (IV's, hydration fluids, antibiotics) to treat patients. Thus, more patients have arrived at the clinic, receive a cholera diagnosis, and then die. By the time the patients arrive at the clinic they have been too far along to respond to ORS, so IVs are needed. There are very few cars in the region so it is difficult to get patients to the City of Anse Rouge clinic, which as of yesterday was also out of IVs and rehydration fluids. As of yesterday, at least five more cholera patients found transport from SEcond Section Commune Anse Rouge to the City of Anse Rouge clinic in the first section. Two more died at the La Source Chaude clinic in Second Section. Five new patients had arrived at the La Source Clinic yesterday. A29 launched a public education and prevention campaign two weeks ago at teh regions two largest public markets (the City of Anse Rouge and the La Source Chaude markets). Information is spread by megaphone regarding prevention of cholera, treatment and how and when to make ORS. As a result of the outbreak in Gonaives, people are afraid to go to Gonaives for fear of contracting cholera. This puts the entire region in a precarious position as most of the region's supplies are procured in Gonaives (rice, oil, gas, everything). Commune Anse Rouge produces shallot and sourghum and pwa congo but no other crops in sufficient quantity to meet people's basic dietary needs - everything comes from Gonaives. There have been reports that one of the first two cholera victims in the region, when being shut out by the clinic and the community, deliberately polluted the drinking water source in Kay Felip, causing the other three people (of the initial five people) to contract cholera. There is a lot of panic and fear as a result, which could all easily be assuaged with the presence of a qualified doctor or nurse and some cholera medical supplies. A29 is currently engaged in efforts to secure supplies and transport for cholera treatment from PAP but has met with great challenges thus far. A29 is also attempting to engage medical teams to bring support to the region, which almost never receives such assistance because of its isolated location NW of Gonaives.

notes: 12/6/10 Email from Amber Munger PIH was responding to the watchboard. It would have been much more helpful if PAHO would have informed everyone that they intended to respond to the watchboard by visiting the site and sending supplies rather than reporting back the day after they visited. They obviously planned the visit the day before they went, meaning that about 48 hours passed between the time that they decided to go and the time that they reported with us. During that time JHPRO, PIH and others made plans to go that would have been a wasteful use of resources had we not caught them. Karine from MSF emailed me today and said that ORS/OPS had also sent supplies to the Lagon clinic. I dont know who that is or what supplies. In the meantime, AMURT is reporting that they sent a doctor to La Source Chaude that was there for three days, but I did not hear this from Hebert or MSPP. I dont think that people using the watchboard understand the importance of information sharing on the response end as well as the need end. 11/4/10 Email from Dr. Grazia Caleo, PAHO Gonaive I am based in Gonaive for PAHO/OMS. I am following the alert situation in the Haut Artibonite. Regarding the situation in Anse Rouge I contacted MSF France they told me that in Source Chaude they set up a UTC in Anse Rouge a points ORS. Also they regularly provide support and supply. (LPar Note: Amber is contacting MSF to coord. and clarify what their support will be. Supply drop was noted in 12/2/10 entry. Staff support needs to be clarified.) ---------------------------------------------- 12/2/10: From conversation with Amber Market days are twice a week Thurs. and Sat. Missionary Air Sities uses airstrip. We were also able to hook them up with CARE for educational materials! Herbert has a meeting with them set up. ------------------------------------------------- 12/2/10 Email from Amber Munger ...still waiting for verifiable information. The volunteer nurse auxiliary in the La Source Chaude Clinic is refusing to give A29 or the community health committee information on cholera patients because we won't provide him with a salary or other means of compensation. As I mentioned before, the nurse auxiliary is a volunteer that does not have a good relationship with the community but is the only medical personnel that the community has. The Communal Director for MSPP (Dr. Carlo) is meeting with the community health committee, community leadership council, A29, and the nurse auxiliary on Friday to resolve the issue. A29's coordinator, Hebert Pierre, at this point can only verify the number of patients that he has seen at the clinic while he has been present in La Source for the last week. In general, the La Source Chaude clinic has had about 15-19 overnight cholera patients per day for the last five days at the CTC. We can confirm, too, that MSF brought 9 boxes of supplies, (presumably hydration fluid) (this is in addition to a large tent and small amt. of supplies that MSPP dropped off after 63 patients were transported)to the La Source Chaude clinic yesterday. After the meeting on Friday I will be able to give an inventory report on what was given. In terms of the Town of Anse Rouge, as I mentioned before, Hebert said that that clinic is closed. When he went to the clinic again on Tuesday to get information there was only a guardian there who could not provide him with any information. He is hoping to establish more formalised lines of communication today and tomorrow as he meets with CARE - who contacted him yesterday - and MSPP on Friday at the community meeting. ------------------------------------------- 11/22/10 Notes from Amber Hebert has not yet even met with the organization in PAP to know what supplies we will get . That appointment is at 10:00 today. The we still ahve to figure out transport for the supplies. As soon as we receive supplies I will let you know. These supplies will be for the La SOurce Chaude clinic FIRST and anything we can spare we will give to teh CIty Clinic. The City Clinic is on Route National One and patients can more easily find transport to Gonaives from that Center. That is not the case where we are in La SOurce Chaude. We need to have supplies at the La SOurce Chaude clinic because those people will not be able to make it to another location easily. It was a blessing that MSPP had a truck available to send to La Source last time. I dont think our luck wil be the same next time around. Water - the La Source Chaude clinic has water as we have hot springs in la Source Chaude (which means, in French, "hot spring"). The nurse auxillary who works there is highly incompetent and does not use the water filter that was set up for the clinic because he does not like the person who installed it. If he decided to use it again it has to be reinstalled and will be at least a few weeks before it is up and running. So we need aquatab or other water disinfectant for the clinic (as well as for the population in general). ---------------------------------------------- 11/21/10 Update on Assessment from Amber Munger When did cholera patients begin to come at this location? 9 or 10 November How many people does your facility serve? There are approximately 37,000 people in Commune Anse Rouge. Normally, the La SOurce Chaude clinic services about 1/6 of the population. Now that all other clinics except the one in the City of Anse Rouge have closed, people are coming from throughout the commune to the La Source Chaude clinic. Current Cholera Patient Load Up until November 18th there were only five cases (all of whom died). However, yesterday 63 patients walked or were transported to the La Source Chaude clinic many of them walking from extremely remote locations where they were expected to have brought cholera from Port-de-Paix. Most of the patients were coming from Tante, Yaya and Bonsinye, extremely high mountain regions that border third section Port-de-Paix. Fatality Rate for Cholera? Five of the five patients who had cholera until November 18th died; one is suspected of intentionally polluting the water source when he was shut out of the clinics, spreading cholera to three other people in the village of Kay Felip. Yesterday, November 20th one patient died and then 63 more people proceeded arrive at teh clinic. These people were transported in a MSPP truck to Gonaives. No one died en route but we are unclear as to what happened after they were deposited in Gonaives. Has number of patients stabilized? Today there were only seven patients in total. Yesterday was market day and people came from very far to the La Source market, explaining the huge increase in numbers. Medical Staffing (eg. no. of Doctors, no. of Nurses, no. of non medical staff): The community health clinic has no paid staff. There is only a volunteer nurse auxillary at the clinic. There are no qualified medical proffessionals (doctors or nurses) in the entire second section Commune Anse Rouge and only one that we know of in the first section. How many patients are you treating daily? Will update in a few days. How many hospitalized? Just transported all patients Does your facility provide Mobile Medical Clinics to the community?we do not have transportation available What is your Cholera Bed Capacity? There were only five beds in the La SOurce clinic. MSPP sent a tent for the clinic to set up in the lakou but have not provided beds. Describe accessibility to your site (e.g. Passable roads? Helicopter Landing Pad or spot? Airstrip for small planes? Please provide conditions for air landings and GPS coordinates). By road, it is a 2 hour trip from Gonaives (one hour on route national one and another hour on teh road from Letan to La Source Chaude). It is a very difficult road, even by Haiti standards. There is a helicopter landing strip in the City of Anse Rouge, which is a one hour drive from La Source Chaude, but is a much easier drive than the trip from Gonaives. Can you pick up supplies? We can pay local trucks to retrieve the supplies. THe local leaders in the community will offer the use of their large transport vehicles. Medical Supply needs (List by PRIORITY please). cholera related supplies and disinfectants. The clinic is also lacking in basic antibiotics for most other treatable illnesses. ---------------------------------------- 11/21/10 Email from Amber Hi folks - Just a quick update on this. Yesterday 63 patients showed up at the La Sources Chaude clinic after noon because all other clinics in Commune Anse Rouge (except for the one in the City of Anse Rouge) closed their doors to cholera patients. A29 Coordinator lobbied MSPP in Gonaives for help. In response, MSPP sent a truck to La Source Chaude to transport the 63 patients to Gonaives. Our coordinator said there were only a few patients who came to the La Source Clinic this morning before he left for PAP to try to seek medical supplies. MSPP sent us some fluid and IVs as well as a tent to set up a CTC in the lakou of the La Sous Clinic. The supplies will not last long. Hebert is in PAP meeting with Americare to see if they would be willing to give us free antibiotics, fluids, clorox for disinfecting the center, and aquatab. As I mentioned before, there are no qualified medical personnel in second section Commune Anse Rouge, and I am not sure that there are any either in the first section either (other than the regional director, who is helping to coordinate rather than see patients). ----------------------------------------- 11/21/10 Email from Amber I am on a call until 8:00 when I will get back to this but for now I wanted to make clear that A29 does not represent the ILODEP clinic. A29 is trying to find support for the community clinics - not the private clinic run by a private organization. I just received word that even the ILODEP clinic closed, just as all of the other private clinics. The private clinics will not accept cholera patients. Since I last wrote you yesterday, the La SOurce Chaude clinic received 63 patients - because all of the other clinics in the entire commune closed except for the City of Anse Rouge clinic which has no materials. Since the La SOurce Chaude clinic also had no materials, our coordinator Hebert Pierre worked with the Ministry of Health to try to find transport to Gonaives for all 63 of the patients. Gonaives is a treacherous two hour drive from La Source Chaude, and not many vehicles make the voyage. I will fill out the information on the sheet that you sent me just as soon as I am off the call with my board. Thanks for your help! ------------------------------------------- 11/21/10 Have requested Assesment information from Amber for clinic. lpar ------------------------------------------- Email from Amber Munger of Article 29 Organization 11/21/10 Commune Anse Rouge has approximately 37,000 residents but also services parts of Terre Neuve, raising the number to about 42,000. Article 29 Organization's base is in Second Section Commune Anse Rouge, which has four physical health clinics. One is the ILODEP clinic sponsored by Parole et Action, the other three are community clinics which have no paid staff and have not received supplies since July, the last time that A29 secured supplies for distribution to the clinics. There is no doctor or nurse in second section Commune Anse Rouge. There is rumored to be a doctor present in the City of Anse Rouge at the tent clinic (in first section Commune Anse Rouge) at the site of the old hospital that burnt down last year. This clinic is between a 2 to 8 hour walk for people in Second Section Commune Anse Rouge and there are virtually no taptaps or cars in the region. Cholera first entered Second Section Commune Anse Rouge about two weeks ago with cases coming in from people who had been in Gonaives. In second Section Commune Anse Rouge, we had five cases last week. The La Source Chaude clinic, which is the main clinic for the second section and is run by a volunteer nurse auxillary, closed its doors for fear of cholera. All five cholera victims died. A29's coordinator lobbied regional MSPP to re-open the clinic, which the volunteer nurse auxillary has now done, but there are currently no supplies (IV's, hydration fluids, antibiotics) to treat patients. Thus, more patients have arrived at the clinic, receive a cholera diagnosis, and then die. By the time the patients arrive at the clinic they have been too far along to respond to ORS, so IVs are needed. There are very few cars in the region so it is difficult to get patients to the City of Anse Rouge clinic, which as of yesterday was also out of IVs and rehydration fluids. As of yesterday, at least five more cholera patients found transport from SEcond Section Commune Anse Rouge to the City of Anse Rouge clinic in the first section. Two more died at the La Source Chaude clinic in Second Section. Five new patients had arrived at the La Source Clinic yesterday. A29 launched a public education and prevention campaign two weeks ago at teh regions two largest public markets (the City of Anse Rouge and the La Source Chaude markets). Information is spread by megaphone regarding prevention of cholera, treatment and how and when to make ORS. As a result of the outbreak in Gonaives, people are afraid to go to Gonaives for fear of contracting cholera. This puts the entire region in a precarious position as most of the region's supplies are procured in Gonaives (rice, oil, gas, everything). Commune Anse Rouge produces shallot and sourghum and pwa congo but no other crops in sufficient quantity to meet people's basic dietary needs - everything comes from Gonaives. There have been reports that one of the first two cholera victims in the region, when being shut out by the clinic and the community, deliberately polluted the drinking water source in Kay Felip, causing the other three people (of the initial five people) to contract cholera. There is a lot of panic and fear as a result, which could all easily be assuaged with the presence of a qualified doctor or nurse and some cholera medical supplies. A29 is currently engaged in efforts to secure supplies and transport for cholera treatment from PAP but has met with great challenges thus far. A29 is also attempting to engage medical teams to bring support to the region, which almost never receives such assistance because of its isolated location NW of Gonaives. -> 12/6/10 Email from Amber Munger PIH was responding to the watchboard. It would have been much more helpful if PAHO would have informed everyone that they intended to respond to the watchboard by visiting the site and sending supplies rather than reporting back the day after they visited. They obviously planned the visit the day before they went, meaning that about 48 hours passed between the time that they decided to go and the time that they reported with us. During that time JHPRO, PIH and others made plans to go that would have been a wasteful use of resources had we not caught them. Karine from MSF emailed me today and said that ORS/OPS had also sent supplies to the Lagon clinic. I dont know who that is or what supplies. In the meantime, AMURT is reporting that they sent a doctor to La Source Chaude that was there for three days, but I did not hear this from Hebert or MSPP. --------------------------------------- 11/4/10 Email from Dr. Grazia Caleo, PAHO Gonaive I am based in Gonaive for PAHO/OMS. I am following the alert situation in the Haut Artibonite. Regarding the situation in Anse Rouge I contacted MSF France they told me that in Source Chaude they set up a UTC in Anse Rouge a points ORS. Also they regularly provide support and supply. (LPar Note: Amber is contacting MSF to coord. and clarify what their support will be. Supply drop was noted in 12/2/10 entry. Staff support needs to be clarified.) ---------------------------------------------- 12/2/10: From conversation with Amber Market days are twice a week Thurs. and Sat. Missionary Air Sities uses airstrip. We were also able to hook them up with CARE for educational materials! Herbert has a meeting with them set up. ------------------------------------------------- 12/2/10 Email from Amber Munger ...still waiting for verifiable information. The volunteer nurse auxiliary in the La Source Chaude Clinic is refusing to give A29 or the community health committee information on cholera patients because we won't provide him with a salary or other means of compensation. As I mentioned before, the nurse auxiliary is a volunteer that does not have a good relationship with the community but is the only medical personnel that the community has. The Communal Director for MSPP (Dr. Carlo) is meeting with the community health committee, community leadership council, A29, and the nurse auxiliary on Friday to resolve the issue. A29's coordinator, Hebert Pierre, at this point can only verify the number of patients that he has seen at the clinic while he has been present in La Source for the last week. In general, the La Source Chaude clinic has had about 15-19 overnight cholera patients per day for the last five days at the CTC. We can confirm, too, that MSF brought 9 boxes of supplies, (presumably hydration fluid) (this is in addition to a large tent and small amt. of supplies that MSPP dropped off after 63 patients were transported)to the La Source Chaude clinic yesterday. After the meeting on Friday I will be able to give an inventory report on what was given. In terms of the Town of Anse Rouge, as I mentioned before, Hebert said that that clinic is closed. When he went to the clinic again on Tuesday to get information there was only a guardian there who could not provide him with any information. He is hoping to establish more formalised lines of communication today and tomorrow as he meets with CARE - who contacted him yesterday - and MSPP on Friday at the community meeting. ------------------------------------------- 11/22/10 Notes from Amber Hebert has not yet even met with the organization in PAP to know what supplies we will get . That appointment is at 10:00 today. The we still ahve to figure out transport for the supplies. As soon as we receive supplies I will let you know. These supplies will be for the La SOurce Chaude clinic FIRST and anything we can spare we will give to teh CIty Clinic. The City Clinic is on Route National One and patients can more easily find transport to Gonaives from that Center. That is not the case where we are in La SOurce Chaude. We need to have supplies at the La SOurce Chaude clinic because those people will not be able to make it to another location easily. It was a blessing that MSPP had a truck available to send to La Source last time. I dont think our luck wil be the same next time around. Water - the La Source Chaude clinic has water as we have hot springs in la Source Chaude (which means, in French, "hot spring"). The nurse auxillary who works there is highly incompetent and does not use the water filter that was set up for the clinic because he does not like the person who installed it. If he decided to use it again it has to be reinstalled and will be at least a few weeks before it is up and running. So we need aquatab or other water disinfectant for the clinic (as well as for the population in general). ---------------------------------------------- 11/21/10 Update on Assessment from Amber Munger When did cholera patients begin to come at this location? 9 or 10 November How many people does your facility serve? There are approximately 37,000 people in Commune Anse Rouge. Normally, the La SOurce Chaude clinic services about 1/6 of the population. Now that all other clinics except the one in the City of Anse Rouge have closed, people are coming from throughout the commune to the La Source Chaude clinic. Current Cholera Patient Load Up until November 18th there were only five cases (all of whom died). However, yesterday 63 patients walked or were transported to the La Source Chaude clinic many of them walking from extremely remote locations where they were expected to have brought cholera from Port-de-Paix. Most of the patients were coming from Tante, Yaya and Bonsinye, extremely high mountain regions that border third section Port-de-Paix. Fatality Rate for Cholera? Five of the five patients who had cholera until November 18th died; one is suspected of intentionally polluting the water source when he was shut out of the clinics, spreading cholera to three other people in the village of Kay Felip. Yesterday, November 20th one patient died and then 63 more people proceeded arrive at teh clinic. These people were transported in a MSPP truck to Gonaives. No one died en route but we are unclear as to what happened after they were deposited in Gonaives. Has number of patients stabilized? Today there were only seven patients in total. Yesterday was market day and people came from very far to the La Source market, explaining the huge increase in numbers. Medical Staffing (eg. no. of Doctors, no. of Nurses, no. of non medical staff): The community health clinic has no paid staff. There is only a volunteer nurse auxillary at the clinic. There are no qualified medical proffessionals (doctors or nurses) in the entire second section Commune Anse Rouge and only one that we know of in the first section. How many patients are you treating daily? Will update in a few days. How many hospitalized? Just transported all patients Does your facility provide Mobile Medical Clinics to the community?we do not have transportation available What is your Cholera Bed Capacity? There were only five beds in the La SOurce clinic. MSPP sent a tent for the clinic to set up in the lakou but have not provided beds. Describe accessibility to your site (e.g. Passable roads? Helicopter Landing Pad or spot? Airstrip for small planes? Please provide conditions for air landings and GPS coordinates). By road, it is a 2 hour trip from Gonaives (one hour on route national one and another hour on teh road from Letan to La Source Chaude). It is a very difficult road, even by Haiti standards. There is a helicopter landing strip in the City of Anse Rouge, which is a one hour drive from La Source Chaude, but is a much easier drive than the trip from Gonaives. Can you pick up supplies? We can pay local trucks to retrieve the supplies. THe local leaders in the community will offer the use of their large transport vehicles. Medical Supply needs (List by PRIORITY please). cholera related supplies and disinfectants. The clinic is also lacking in basic antibiotics for most other treatable illnesses. ---------------------------------------- 11/21/10 Email from Amber Hi folks - Just a quick update on this. Yesterday 63 patients showed up at the La Sources Chaude clinic after noon because all other clinics in Commune Anse Rouge (except for the one in the City of Anse Rouge) closed their doors to cholera patients. A29 Coordinator lobbied MSPP in Gonaives for help. In response, MSPP sent a truck to La Source Chaude to transport the 63 patients to Gonaives. Our coordinator said there were only a few patients who came to the La Source Clinic this morning before he left for PAP to try to seek medical supplies. MSPP sent us some fluid and IVs as well as a tent to set up a CTC in the lakou of the La Sous Clinic. The supplies will not last long. Hebert is in PAP meeting with Americare to see if they would be willing to give us free antibiotics, fluids, clorox for disinfecting the center, and aquatab. As I mentioned before, there are no qualified medical personnel in second section Commune Anse Rouge, and I am not sure that there are any either in the first section either (other than the regional director, who is helping to coordinate rather than see patients). ----------------------------------------- 11/21/10 Email from Amber I am on a call until 8:00 when I will get back to this but for now I wanted to make clear that A29 does not represent the ILODEP clinic. A29 is trying to find support for the community clinics - not the private clinic run by a private organization. I just received word that even the ILODEP clinic closed, just as all of the other private clinics. The private clinics will not accept cholera patients. Since I last wrote you yesterday, the La SOurce Chaude clinic received 63 patients - because all of the other clinics in the entire commune closed except for the City of Anse Rouge clinic which has no materials. Since the La SOurce Chaude clinic also had no materials, our coordinator Hebert Pierre worked with the Ministry of Health to try to find transport to Gonaives for all 63 of the patients. Gonaives is a treacherous two hour drive from La Source Chaude, and not many vehicles make the voyage. I will fill out the information on the sheet that you sent me just as soon as I am off the call with my board. Thanks for your help! ------------------------------------------- 11/21/10 Have requested Assesment information from Amber for clinic. lpar ------------------------------------------- Email from Amber Munger of Article 29 Organization 11/21/10 Commune Anse Rouge has approximately 37,000 residents but also services parts of Terre Neuve, raising the number to about 42,000. Article 29 Organization's base is in Second Section Commune Anse Rouge, which has four physical health clinics. One is the ILODEP clinic sponsored by Parole et Action, the other three are community clinics which have no paid staff and have not received supplies since July, the last time that A29 secured supplies for distribution to the clinics. There is no doctor or nurse in second section Commune Anse Rouge. There is rumored to be a doctor present in the City of Anse Rouge at the tent clinic (in first section Commune Anse Rouge) at the site of the old hospital that burnt down last year. This clinic is between a 2 to 8 hour walk for people in Second Section Commune Anse Rouge and there are virtually no taptaps or cars in the region. Cholera first entered Second Section Commune Anse Rouge about two weeks ago with cases coming in from people who had been in Gonaives. In second Section Commune Anse Rouge, we had five cases last week. The La Source Chaude clinic, which is the main clinic for the second section and is run by a volunteer nurse auxillary, closed its doors for fear of cholera. All five cholera victims died. A29's coordinator lobbied regional MSPP to re-open the clinic, which the volunteer nurse auxillary has now done, but there are currently no supplies (IV's, hydration fluids, antibiotics) to treat patients. Thus, more patients have arrived at the clinic, receive a cholera diagnosis, and then die. By the time the patients arrive at the clinic they have been too far along to respond to ORS, so IVs are needed. There are very few cars in the region so it is difficult to get patients to the City of Anse Rouge clinic, which as of yesterday was also out of IVs and rehydration fluids. As of yesterday, at least five more cholera patients found transport from SEcond Section Commune Anse Rouge to the City of Anse Rouge clinic in the first section. Two more died at the La Source Chaude clinic in Second Section. Five new patients had arrived at the La Source Clinic yesterday. A29 launched a public education and prevention campaign two weeks ago at teh regions two largest public markets (the City of Anse Rouge and the La Source Chaude markets). Information is spread by megaphone regarding prevention of cholera, treatment and how and when to make ORS. As a result of the outbreak in Gonaives, people are afraid to go to Gonaives for fear of contracting cholera. This puts the entire region in a precarious position as most of the region's supplies are procured in Gonaives (rice, oil, gas, everything). Commune Anse Rouge produces shallot and sourghum and pwa congo but no other crops in sufficient quantity to meet people's basic dietary needs - everything comes from Gonaives. There have been reports that one of the first two cholera victims in the region, when being shut out by the clinic and the community, deliberately polluted the drinking water source in Kay Felip, causing the other three people (of the initial five people) to contract cholera. There is a lot of panic and fear as a result, which could all easily be assuaged with the presence of a qualified doctor or nurse and some cholera medical supplies. A29 is currently engaged in efforts to secure supplies and transport for cholera treatment from PAP but has met with great challenges thus far. A29 is also attempting to engage medical teams to bring support to the region, which almost never receives such assistance because of its isolated location NW of Gonaives.

notes: 11/4/10 Email from Dr. Grazia Caleo, PAHO Gonaive I am based in Gonaive for PAHO/OMS. I am following the alert situation in the Haut Artibonite. Regarding the situation in Anse Rouge I contacted MSF France they told me that in Source Chaude they set up a UTC in Anse Rouge a points ORS. Also they regularly provide support and supply. (LPar Note: Amber is contacting MSF to coord. and clarify what their support will be. Supply drop was noted in 12/2/10 entry. Staff support needs to be clarified.) ---------------------------------------------- 12/2/10: From conversation with Amber Market days are twice a week Thurs. and Sat. Missionary Air Sities uses airstrip. We were also able to hook them up with CARE for educational materials! Herbert has a meeting with them set up. ------------------------------------------------- 12/2/10 Email from Amber Munger ...still waiting for verifiable information. The volunteer nurse auxiliary in the La Source Chaude Clinic is refusing to give A29 or the community health committee information on cholera patients because we won't provide him with a salary or other means of compensation. As I mentioned before, the nurse auxiliary is a volunteer that does not have a good relationship with the community but is the only medical personnel that the community has. The Communal Director for MSPP (Dr. Carlo) is meeting with the community health committee, community leadership council, A29, and the nurse auxiliary on Friday to resolve the issue. A29's coordinator, Hebert Pierre, at this point can only verify the number of patients that he has seen at the clinic while he has been present in La Source for the last week. In general, the La Source Chaude clinic has had about 15-19 overnight cholera patients per day for the last five days at the CTC. We can confirm, too, that MSF brought 9 boxes of supplies, (presumably hydration fluid) (this is in addition to a large tent and small amt. of supplies that MSPP dropped off after 63 patients were transported)to the La Source Chaude clinic yesterday. After the meeting on Friday I will be able to give an inventory report on what was given. In terms of the Town of Anse Rouge, as I mentioned before, Hebert said that that clinic is closed. When he went to the clinic again on Tuesday to get information there was only a guardian there who could not provide him with any information. He is hoping to establish more formalised lines of communication today and tomorrow as he meets with CARE - who contacted him yesterday - and MSPP on Friday at the community meeting. ------------------------------------------- 11/22/10 Notes from Amber Hebert has not yet even met with the organization in PAP to know what supplies we will get . That appointment is at 10:00 today. The we still ahve to figure out transport for the supplies. As soon as we receive supplies I will let you know. These supplies will be for the La SOurce Chaude clinic FIRST and anything we can spare we will give to teh CIty Clinic. The City Clinic is on Route National One and patients can more easily find transport to Gonaives from that Center. That is not the case where we are in La SOurce Chaude. We need to have supplies at the La SOurce Chaude clinic because those people will not be able to make it to another location easily. It was a blessing that MSPP had a truck available to send to La Source last time. I dont think our luck wil be the same next time around. Water - the La Source Chaude clinic has water as we have hot springs in la Source Chaude (which means, in French, "hot spring"). The nurse auxillary who works there is highly incompetent and does not use the water filter that was set up for the clinic because he does not like the person who installed it. If he decided to use it again it has to be reinstalled and will be at least a few weeks before it is up and running. So we need aquatab or other water disinfectant for the clinic (as well as for the population in general). ---------------------------------------------- 11/21/10 Update on Assessment from Amber Munger When did cholera patients begin to come at this location? 9 or 10 November How many people does your facility serve? There are approximately 37,000 people in Commune Anse Rouge. Normally, the La SOurce Chaude clinic services about 1/6 of the population. Now that all other clinics except the one in the City of Anse Rouge have closed, people are coming from throughout the commune to the La Source Chaude clinic. Current Cholera Patient Load Up until November 18th there were only five cases (all of whom died). However, yesterday 63 patients walked or were transported to the La Source Chaude clinic many of them walking from extremely remote locations where they were expected to have brought cholera from Port-de-Paix. Most of the patients were coming from Tante, Yaya and Bonsinye, extremely high mountain regions that border third section Port-de-Paix. Fatality Rate for Cholera? Five of the five patients who had cholera until November 18th died; one is suspected of intentionally polluting the water source when he was shut out of the clinics, spreading cholera to three other people in the village of Kay Felip. Yesterday, November 20th one patient died and then 63 more people proceeded arrive at teh clinic. These people were transported in a MSPP truck to Gonaives. No one died en route but we are unclear as to what happened after they were deposited in Gonaives. Has number of patients stabilized? Today there were only seven patients in total. Yesterday was market day and people came from very far to the La Source market, explaining the huge increase in numbers. Medical Staffing (eg. no. of Doctors, no. of Nurses, no. of non medical staff): The community health clinic has no paid staff. There is only a volunteer nurse auxillary at the clinic. There are no qualified medical proffessionals (doctors or nurses) in the entire second section Commune Anse Rouge and only one that we know of in the first section. How many patients are you treating daily? Will update in a few days. How many hospitalized? Just transported all patients Does your facility provide Mobile Medical Clinics to the community?we do not have transportation available What is your Cholera Bed Capacity? There were only five beds in the La SOurce clinic. MSPP sent a tent for the clinic to set up in the lakou but have not provided beds. Describe accessibility to your site (e.g. Passable roads? Helicopter Landing Pad or spot? Airstrip for small planes? Please provide conditions for air landings and GPS coordinates). By road, it is a 2 hour trip from Gonaives (one hour on route national one and another hour on teh road from Letan to La Source Chaude). It is a very difficult road, even by Haiti standards. There is a helicopter landing strip in the City of Anse Rouge, which is a one hour drive from La Source Chaude, but is a much easier drive than the trip from Gonaives. Can you pick up supplies? We can pay local trucks to retrieve the supplies. THe local leaders in the community will offer the use of their large transport vehicles. Medical Supply needs (List by PRIORITY please). cholera related supplies and disinfectants. The clinic is also lacking in basic antibiotics for most other treatable illnesses. ---------------------------------------- 11/21/10 Email from Amber Hi folks - Just a quick update on this. Yesterday 63 patients showed up at the La Sources Chaude clinic after noon because all other clinics in Commune Anse Rouge (except for the one in the City of Anse Rouge) closed their doors to cholera patients. A29 Coordinator lobbied MSPP in Gonaives for help. In response, MSPP sent a truck to La Source Chaude to transport the 63 patients to Gonaives. Our coordinator said there were only a few patients who came to the La Source Clinic this morning before he left for PAP to try to seek medical supplies. MSPP sent us some fluid and IVs as well as a tent to set up a CTC in the lakou of the La Sous Clinic. The supplies will not last long. Hebert is in PAP meeting with Americare to see if they would be willing to give us free antibiotics, fluids, clorox for disinfecting the center, and aquatab. As I mentioned before, there are no qualified medical personnel in second section Commune Anse Rouge, and I am not sure that there are any either in the first section either (other than the regional director, who is helping to coordinate rather than see patients). ----------------------------------------- 11/21/10 Email from Amber I am on a call until 8:00 when I will get back to this but for now I wanted to make clear that A29 does not represent the ILODEP clinic. A29 is trying to find support for the community clinics - not the private clinic run by a private organization. I just received word that even the ILODEP clinic closed, just as all of the other private clinics. The private clinics will not accept cholera patients. Since I last wrote you yesterday, the La SOurce Chaude clinic received 63 patients - because all of the other clinics in the entire commune closed except for the City of Anse Rouge clinic which has no materials. Since the La SOurce Chaude clinic also had no materials, our coordinator Hebert Pierre worked with the Ministry of Health to try to find transport to Gonaives for all 63 of the patients. Gonaives is a treacherous two hour drive from La Source Chaude, and not many vehicles make the voyage. I will fill out the information on the sheet that you sent me just as soon as I am off the call with my board. Thanks for your help! ------------------------------------------- 11/21/10 Have requested Assesment information from Amber for clinic. lpar ------------------------------------------- Email from Amber Munger of Article 29 Organization 11/21/10 Commune Anse Rouge has approximately 37,000 residents but also services parts of Terre Neuve, raising the number to about 42,000. Article 29 Organization's base is in Second Section Commune Anse Rouge, which has four physical health clinics. One is the ILODEP clinic sponsored by Parole et Action, the other three are community clinics which have no paid staff and have not received supplies since July, the last time that A29 secured supplies for distribution to the clinics. There is no doctor or nurse in second section Commune Anse Rouge. There is rumored to be a doctor present in the City of Anse Rouge at the tent clinic (in first section Commune Anse Rouge) at the site of the old hospital that burnt down last year. This clinic is between a 2 to 8 hour walk for people in Second Section Commune Anse Rouge and there are virtually no taptaps or cars in the region. Cholera first entered Second Section Commune Anse Rouge about two weeks ago with cases coming in from people who had been in Gonaives. In second Section Commune Anse Rouge, we had five cases last week. The La Source Chaude clinic, which is the main clinic for the second section and is run by a volunteer nurse auxillary, closed its doors for fear of cholera. All five cholera victims died. A29's coordinator lobbied regional MSPP to re-open the clinic, which the volunteer nurse auxillary has now done, but there are currently no supplies (IV's, hydration fluids, antibiotics) to treat patients. Thus, more patients have arrived at the clinic, receive a cholera diagnosis, and then die. By the time the patients arrive at the clinic they have been too far along to respond to ORS, so IVs are needed. There are very few cars in the region so it is difficult to get patients to the City of Anse Rouge clinic, which as of yesterday was also out of IVs and rehydration fluids. As of yesterday, at least five more cholera patients found transport from SEcond Section Commune Anse Rouge to the City of Anse Rouge clinic in the first section. Two more died at the La Source Chaude clinic in Second Section. Five new patients had arrived at the La Source Clinic yesterday. A29 launched a public education and prevention campaign two weeks ago at teh regions two largest public markets (the City of Anse Rouge and the La Source Chaude markets). Information is spread by megaphone regarding prevention of cholera, treatment and how and when to make ORS. As a result of the outbreak in Gonaives, people are afraid to go to Gonaives for fear of contracting cholera. This puts the entire region in a precarious position as most of the region's supplies are procured in Gonaives (rice, oil, gas, everything). Commune Anse Rouge produces shallot and sourghum and pwa congo but no other crops in sufficient quantity to meet people's basic dietary needs - everything comes from Gonaives. There have been reports that one of the first two cholera victims in the region, when being shut out by the clinic and the community, deliberately polluted the drinking water source in Kay Felip, causing the other three people (of the initial five people) to contract cholera. There is a lot of panic and fear as a result, which could all easily be assuaged with the presence of a qualified doctor or nurse and some cholera medical supplies. A29 is currently engaged in efforts to secure supplies and transport for cholera treatment from PAP but has met with great challenges thus far. A29 is also attempting to engage medical teams to bring support to the region, which almost never receives such assistance because of its isolated location NW of Gonaives. -> 12/6/10 Email from Amber Munger PIH was responding to the watchboard. It would have been much more helpful if PAHO would have informed everyone that they intended to respond to the watchboard by visiting the site and sending supplies rather than reporting back the day after they visited. They obviously planned the visit the day before they went, meaning that about 48 hours passed between the time that they decided to go and the time that they reported with us. During that time JHPRO, PIH and others made plans to go that would have been a wasteful use of resources had we not caught them. Karine from MSF emailed me today and said that ORS/OPS had also sent supplies to the Lagon clinic. I dont know who that is or what supplies. In the meantime, AMURT is reporting that they sent a doctor to La Source Chaude that was there for three days, but I did not hear this from Hebert or MSPP. I dont think that people using the watchboard understand the importance of information sharing on the response end as well as the need end. 11/4/10 Email from Dr. Grazia Caleo, PAHO Gonaive I am based in Gonaive for PAHO/OMS. I am following the alert situation in the Haut Artibonite. Regarding the situation in Anse Rouge I contacted MSF France they told me that in Source Chaude they set up a UTC in Anse Rouge a points ORS. Also they regularly provide support and supply. (LPar Note: Amber is contacting MSF to coord. and clarify what their support will be. Supply drop was noted in 12/2/10 entry. Staff support needs to be clarified.) ---------------------------------------------- 12/2/10: From conversation with Amber Market days are twice a week Thurs. and Sat. Missionary Air Sities uses airstrip. We were also able to hook them up with CARE for educational materials! Herbert has a meeting with them set up. ------------------------------------------------- 12/2/10 Email from Amber Munger ...still waiting for verifiable information. The volunteer nurse auxiliary in the La Source Chaude Clinic is refusing to give A29 or the community health committee information on cholera patients because we won't provide him with a salary or other means of compensation. As I mentioned before, the nurse auxiliary is a volunteer that does not have a good relationship with the community but is the only medical personnel that the community has. The Communal Director for MSPP (Dr. Carlo) is meeting with the community health committee, community leadership council, A29, and the nurse auxiliary on Friday to resolve the issue. A29's coordinator, Hebert Pierre, at this point can only verify the number of patients that he has seen at the clinic while he has been present in La Source for the last week. In general, the La Source Chaude clinic has had about 15-19 overnight cholera patients per day for the last five days at the CTC. We can confirm, too, that MSF brought 9 boxes of supplies, (presumably hydration fluid) (this is in addition to a large tent and small amt. of supplies that MSPP dropped off after 63 patients were transported)to the La Source Chaude clinic yesterday. After the meeting on Friday I will be able to give an inventory report on what was given. In terms of the Town of Anse Rouge, as I mentioned before, Hebert said that that clinic is closed. When he went to the clinic again on Tuesday to get information there was only a guardian there who could not provide him with any information. He is hoping to establish more formalised lines of communication today and tomorrow as he meets with CARE - who contacted him yesterday - and MSPP on Friday at the community meeting. ------------------------------------------- 11/22/10 Notes from Amber Hebert has not yet even met with the organization in PAP to know what supplies we will get . That appointment is at 10:00 today. The we still ahve to figure out transport for the supplies. As soon as we receive supplies I will let you know. These supplies will be for the La SOurce Chaude clinic FIRST and anything we can spare we will give to teh CIty Clinic. The City Clinic is on Route National One and patients can more easily find transport to Gonaives from that Center. That is not the case where we are in La SOurce Chaude. We need to have supplies at the La SOurce Chaude clinic because those people will not be able to make it to another location easily. It was a blessing that MSPP had a truck available to send to La Source last time. I dont think our luck wil be the same next time around. Water - the La Source Chaude clinic has water as we have hot springs in la Source Chaude (which means, in French, "hot spring"). The nurse auxillary who works there is highly incompetent and does not use the water filter that was set up for the clinic because he does not like the person who installed it. If he decided to use it again it has to be reinstalled and will be at least a few weeks before it is up and running. So we need aquatab or other water disinfectant for the clinic (as well as for the population in general). ---------------------------------------------- 11/21/10 Update on Assessment from Amber Munger When did cholera patients begin to come at this location? 9 or 10 November How many people does your facility serve? There are approximately 37,000 people in Commune Anse Rouge. Normally, the La SOurce Chaude clinic services about 1/6 of the population. Now that all other clinics except the one in the City of Anse Rouge have closed, people are coming from throughout the commune to the La Source Chaude clinic. Current Cholera Patient Load Up until November 18th there were only five cases (all of whom died). However, yesterday 63 patients walked or were transported to the La Source Chaude clinic many of them walking from extremely remote locations where they were expected to have brought cholera from Port-de-Paix. Most of the patients were coming from Tante, Yaya and Bonsinye, extremely high mountain regions that border third section Port-de-Paix. Fatality Rate for Cholera? Five of the five patients who had cholera until November 18th died; one is suspected of intentionally polluting the water source when he was shut out of the clinics, spreading cholera to three other people in the village of Kay Felip. Yesterday, November 20th one patient died and then 63 more people proceeded arrive at teh clinic. These people were transported in a MSPP truck to Gonaives. No one died en route but we are unclear as to what happened after they were deposited in Gonaives. Has number of patients stabilized? Today there were only seven patients in total. Yesterday was market day and people came from very far to the La Source market, explaining the huge increase in numbers. Medical Staffing (eg. no. of Doctors, no. of Nurses, no. of non medical staff): The community health clinic has no paid staff. There is only a volunteer nurse auxillary at the clinic. There are no qualified medical proffessionals (doctors or nurses) in the entire second section Commune Anse Rouge and only one that we know of in the first section. How many patients are you treating daily? Will update in a few days. How many hospitalized? Just transported all patients Does your facility provide Mobile Medical Clinics to the community?we do not have transportation available What is your Cholera Bed Capacity? There were only five beds in the La SOurce clinic. MSPP sent a tent for the clinic to set up in the lakou but have not provided beds. Describe accessibility to your site (e.g. Passable roads? Helicopter Landing Pad or spot? Airstrip for small planes? Please provide conditions for air landings and GPS coordinates). By road, it is a 2 hour trip from Gonaives (one hour on route national one and another hour on teh road from Letan to La Source Chaude). It is a very difficult road, even by Haiti standards. There is a helicopter landing strip in the City of Anse Rouge, which is a one hour drive from La Source Chaude, but is a much easier drive than the trip from Gonaives. Can you pick up supplies? We can pay local trucks to retrieve the supplies. THe local leaders in the community will offer the use of their large transport vehicles. Medical Supply needs (List by PRIORITY please). cholera related supplies and disinfectants. The clinic is also lacking in basic antibiotics for most other treatable illnesses. ---------------------------------------- 11/21/10 Email from Amber Hi folks - Just a quick update on this. Yesterday 63 patients showed up at the La Sources Chaude clinic after noon because all other clinics in Commune Anse Rouge (except for the one in the City of Anse Rouge) closed their doors to cholera patients. A29 Coordinator lobbied MSPP in Gonaives for help. In response, MSPP sent a truck to La Source Chaude to transport the 63 patients to Gonaives. Our coordinator said there were only a few patients who came to the La Source Clinic this morning before he left for PAP to try to seek medical supplies. MSPP sent us some fluid and IVs as well as a tent to set up a CTC in the lakou of the La Sous Clinic. The supplies will not last long. Hebert is in PAP meeting with Americare to see if they would be willing to give us free antibiotics, fluids, clorox for disinfecting the center, and aquatab. As I mentioned before, there are no qualified medical personnel in second section Commune Anse Rouge, and I am not sure that there are any either in the first section either (other than the regional director, who is helping to coordinate rather than see patients). ----------------------------------------- 11/21/10 Email from Amber I am on a call until 8:00 when I will get back to this but for now I wanted to make clear that A29 does not represent the ILODEP clinic. A29 is trying to find support for the community clinics - not the private clinic run by a private organization. I just received word that even the ILODEP clinic closed, just as all of the other private clinics. The private clinics will not accept cholera patients. Since I last wrote you yesterday, the La SOurce Chaude clinic received 63 patients - because all of the other clinics in the entire commune closed except for the City of Anse Rouge clinic which has no materials. Since the La SOurce Chaude clinic also had no materials, our coordinator Hebert Pierre worked with the Ministry of Health to try to find transport to Gonaives for all 63 of the patients. Gonaives is a treacherous two hour drive from La Source Chaude, and not many vehicles make the voyage. I will fill out the information on the sheet that you sent me just as soon as I am off the call with my board. Thanks for your help! ------------------------------------------- 11/21/10 Have requested Assesment information from Amber for clinic. lpar ------------------------------------------- Email from Amber Munger of Article 29 Organization 11/21/10 Commune Anse Rouge has approximately 37,000 residents but also services parts of Terre Neuve, raising the number to about 42,000. Article 29 Organization's base is in Second Section Commune Anse Rouge, which has four physical health clinics. One is the ILODEP clinic sponsored by Parole et Action, the other three are community clinics which have no paid staff and have not received supplies since July, the last time that A29 secured supplies for distribution to the clinics. There is no doctor or nurse in second section Commune Anse Rouge. There is rumored to be a doctor present in the City of Anse Rouge at the tent clinic (in first section Commune Anse Rouge) at the site of the old hospital that burnt down last year. This clinic is between a 2 to 8 hour walk for people in Second Section Commune Anse Rouge and there are virtually no taptaps or cars in the region. Cholera first entered Second Section Commune Anse Rouge about two weeks ago with cases coming in from people who had been in Gonaives. In second Section Commune Anse Rouge, we had five cases last week. The La Source Chaude clinic, which is the main clinic for the second section and is run by a volunteer nurse auxillary, closed its doors for fear of cholera. All five cholera victims died. A29's coordinator lobbied regional MSPP to re-open the clinic, which the volunteer nurse auxillary has now done, but there are currently no supplies (IV's, hydration fluids, antibiotics) to treat patients. Thus, more patients have arrived at the clinic, receive a cholera diagnosis, and then die. By the time the patients arrive at the clinic they have been too far along to respond to ORS, so IVs are needed. There are very few cars in the region so it is difficult to get patients to the City of Anse Rouge clinic, which as of yesterday was also out of IVs and rehydration fluids. As of yesterday, at least five more cholera patients found transport from SEcond Section Commune Anse Rouge to the City of Anse Rouge clinic in the first section. Two more died at the La Source Chaude clinic in Second Section. Five new patients had arrived at the La Source Clinic yesterday. A29 launched a public education and prevention campaign two weeks ago at teh regions two largest public markets (the City of Anse Rouge and the La Source Chaude markets). Information is spread by megaphone regarding prevention of cholera, treatment and how and when to make ORS. As a result of the outbreak in Gonaives, people are afraid to go to Gonaives for fear of contracting cholera. This puts the entire region in a precarious position as most of the region's supplies are procured in Gonaives (rice, oil, gas, everything). Commune Anse Rouge produces shallot and sourghum and pwa congo but no other crops in sufficient quantity to meet people's basic dietary needs - everything comes from Gonaives. There have been reports that one of the first two cholera victims in the region, when being shut out by the clinic and the community, deliberately polluted the drinking water source in Kay Felip, causing the other three people (of the initial five people) to contract cholera. There is a lot of panic and fear as a result, which could all easily be assuaged with the presence of a qualified doctor or nurse and some cholera medical supplies. A29 is currently engaged in efforts to secure supplies and transport for cholera treatment from PAP but has met with great challenges thus far. A29 is also attempting to engage medical teams to bring support to the region, which almost never receives such assistance because of its isolated location NW of Gonaives.

notes: 12/2/10: From conversation with Amber Market days are twice a week Thurs. and Sat. Missionary Air Sities uses airstrip. We were also able to hook them up with CARE for educational materials! Herbert has a meeting with them set up. ------------------------------------------------- 12/2/10 Email from Amber Munger ...still waiting for verifiable information. The volunteer nurse auxiliary in the La Source Chaude Clinic is refusing to give A29 or the community health committee information on cholera patients because we won't provide him with a salary or other means of compensation. As I mentioned before, the nurse auxiliary is a volunteer that does not have a good relationship with the community but is the only medical personnel that the community has. The Communal Director for MSPP (Dr. Carlo) is meeting with the community health committee, community leadership council, A29, and the nurse auxiliary on Friday to resolve the issue. A29's coordinator, Hebert Pierre, at this point can only verify the number of patients that he has seen at the clinic while he has been present in La Source for the last week. In general, the La Source Chaude clinic has had about 15-19 overnight cholera patients per day for the last five days at the CTC. We can confirm, too, that MSF brought 9 boxes of supplies, (presumably hydration fluid) (this is in addition to a large tent and small amt. of supplies that MSPP dropped off after 63 patients were transported)to the La Source Chaude clinic yesterday. After the meeting on Friday I will be able to give an inventory report on what was given. In terms of the Town of Anse Rouge, as I mentioned before, Hebert said that that clinic is closed. When he went to the clinic again on Tuesday to get information there was only a guardian there who could not provide him with any information. He is hoping to establish more formalised lines of communication today and tomorrow as he meets with CARE - who contacted him yesterday - and MSPP on Friday at the community meeting. ------------------------------------------- 11/22/10 Notes from Amber Hebert has not yet even met with the organization in PAP to know what supplies we will get . That appointment is at 10:00 today. The we still ahve to figure out transport for the supplies. As soon as we receive supplies I will let you know. These supplies will be for the La SOurce Chaude clinic FIRST and anything we can spare we will give to teh CIty Clinic. The City Clinic is on Route National One and patients can more easily find transport to Gonaives from that Center. That is not the case where we are in La SOurce Chaude. We need to have supplies at the La SOurce Chaude clinic because those people will not be able to make it to another location easily. It was a blessing that MSPP had a truck available to send to La Source last time. I dont think our luck wil be the same next time around. Water - the La Source Chaude clinic has water as we have hot springs in la Source Chaude (which means, in French, "hot spring"). The nurse auxillary who works there is highly incompetent and does not use the water filter that was set up for the clinic because he does not like the person who installed it. If he decided to use it again it has to be reinstalled and will be at least a few weeks before it is up and running. So we need aquatab or other water disinfectant for the clinic (as well as for the population in general). ---------------------------------------------- 11/21/10 Update on Assessment from Amber Munger When did cholera patients begin to come at this location? 9 or 10 November How many people does your facility serve? There are approximately 37,000 people in Commune Anse Rouge. Normally, the La SOurce Chaude clinic services about 1/6 of the population. Now that all other clinics except the one in the City of Anse Rouge have closed, people are coming from throughout the commune to the La Source Chaude clinic. Current Cholera Patient Load Up until November 18th there were only five cases (all of whom died). However, yesterday 63 patients walked or were transported to the La Source Chaude clinic many of them walking from extremely remote locations where they were expected to have brought cholera from Port-de-Paix. Most of the patients were coming from Tante, Yaya and Bonsinye, extremely high mountain regions that border third section Port-de-Paix. Fatality Rate for Cholera? Five of the five patients who had cholera until November 18th died; one is suspected of intentionally polluting the water source when he was shut out of the clinics, spreading cholera to three other people in the village of Kay Felip. Yesterday, November 20th one patient died and then 63 more people proceeded arrive at teh clinic. These people were transported in a MSPP truck to Gonaives. No one died en route but we are unclear as to what happened after they were deposited in Gonaives. Has number of patients stabilized? Today there were only seven patients in total. Yesterday was market day and people came from very far to the La Source market, explaining the huge increase in numbers. Medical Staffing (eg. no. of Doctors, no. of Nurses, no. of non medical staff): The community health clinic has no paid staff. There is only a volunteer nurse auxillary at the clinic. There are no qualified medical proffessionals (doctors or nurses) in the entire second section Commune Anse Rouge and only one that we know of in the first section. How many patients are you treating daily? Will update in a few days. How many hospitalized? Just transported all patients Does your facility provide Mobile Medical Clinics to the community?we do not have transportation available What is your Cholera Bed Capacity? There were only five beds in the La SOurce clinic. MSPP sent a tent for the clinic to set up in the lakou but have not provided beds. Describe accessibility to your site (e.g. Passable roads? Helicopter Landing Pad or spot? Airstrip for small planes? Please provide conditions for air landings and GPS coordinates). By road, it is a 2 hour trip from Gonaives (one hour on route national one and another hour on teh road from Letan to La Source Chaude). It is a very difficult road, even by Haiti standards. There is a helicopter landing strip in the City of Anse Rouge, which is a one hour drive from La Source Chaude, but is a much easier drive than the trip from Gonaives. Can you pick up supplies? We can pay local trucks to retrieve the supplies. THe local leaders in the community will offer the use of their large transport vehicles. Medical Supply needs (List by PRIORITY please). cholera related supplies and disinfectants. The clinic is also lacking in basic antibiotics for most other treatable illnesses. ---------------------------------------- 11/21/10 Email from Amber Hi folks - Just a quick update on this. Yesterday 63 patients showed up at the La Sources Chaude clinic after noon because all other clinics in Commune Anse Rouge (except for the one in the City of Anse Rouge) closed their doors to cholera patients. A29 Coordinator lobbied MSPP in Gonaives for help. In response, MSPP sent a truck to La Source Chaude to transport the 63 patients to Gonaives. Our coordinator said there were only a few patients who came to the La Source Clinic this morning before he left for PAP to try to seek medical supplies. MSPP sent us some fluid and IVs as well as a tent to set up a CTC in the lakou of the La Sous Clinic. The supplies will not last long. Hebert is in PAP meeting with Americare to see if they would be willing to give us free antibiotics, fluids, clorox for disinfecting the center, and aquatab. As I mentioned before, there are no qualified medical personnel in second section Commune Anse Rouge, and I am not sure that there are any either in the first section either (other than the regional director, who is helping to coordinate rather than see patients). ----------------------------------------- 11/21/10 Email from Amber I am on a call until 8:00 when I will get back to this but for now I wanted to make clear that A29 does not represent the ILODEP clinic. A29 is trying to find support for the community clinics - not the private clinic run by a private organization. I just received word that even the ILODEP clinic closed, just as all of the other private clinics. The private clinics will not accept cholera patients. Since I last wrote you yesterday, the La SOurce Chaude clinic received 63 patients - because all of the other clinics in the entire commune closed except for the City of Anse Rouge clinic which has no materials. Since the La SOurce Chaude clinic also had no materials, our coordinator Hebert Pierre worked with the Ministry of Health to try to find transport to Gonaives for all 63 of the patients. Gonaives is a treacherous two hour drive from La Source Chaude, and not many vehicles make the voyage. I will fill out the information on the sheet that you sent me just as soon as I am off the call with my board. Thanks for your help! ------------------------------------------- 11/21/10 Have requested Assesment information from Amber for clinic. lpar ------------------------------------------- Email from Amber Munger of Article 29 Organization 11/21/10 Commune Anse Rouge has approximately 37,000 residents but also services parts of Terre Neuve, raising the number to about 42,000. Article 29 Organization's base is in Second Section Commune Anse Rouge, which has four physical health clinics. One is the ILODEP clinic sponsored by Parole et Action, the other three are community clinics which have no paid staff and have not received supplies since July, the last time that A29 secured supplies for distribution to the clinics. There is no doctor or nurse in second section Commune Anse Rouge. There is rumored to be a doctor present in the City of Anse Rouge at the tent clinic (in first section Commune Anse Rouge) at the site of the old hospital that burnt down last year. This clinic is between a 2 to 8 hour walk for people in Second Section Commune Anse Rouge and there are virtually no taptaps or cars in the region. Cholera first entered Second Section Commune Anse Rouge about two weeks ago with cases coming in from people who had been in Gonaives. In second Section Commune Anse Rouge, we had five cases last week. The La Source Chaude clinic, which is the main clinic for the second section and is run by a volunteer nurse auxillary, closed its doors for fear of cholera. All five cholera victims died. A29's coordinator lobbied regional MSPP to re-open the clinic, which the volunteer nurse auxillary has now done, but there are currently no supplies (IV's, hydration fluids, antibiotics) to treat patients. Thus, more patients have arrived at the clinic, receive a cholera diagnosis, and then die. By the time the patients arrive at the clinic they have been too far along to respond to ORS, so IVs are needed. There are very few cars in the region so it is difficult to get patients to the City of Anse Rouge clinic, which as of yesterday was also out of IVs and rehydration fluids. As of yesterday, at least five more cholera patients found transport from SEcond Section Commune Anse Rouge to the City of Anse Rouge clinic in the first section. Two more died at the La Source Chaude clinic in Second Section. Five new patients had arrived at the La Source Clinic yesterday. A29 launched a public education and prevention campaign two weeks ago at teh regions two largest public markets (the City of Anse Rouge and the La Source Chaude markets). Information is spread by megaphone regarding prevention of cholera, treatment and how and when to make ORS. As a result of the outbreak in Gonaives, people are afraid to go to Gonaives for fear of contracting cholera. This puts the entire region in a precarious position as most of the region's supplies are procured in Gonaives (rice, oil, gas, everything). Commune Anse Rouge produces shallot and sourghum and pwa congo but no other crops in sufficient quantity to meet people's basic dietary needs - everything comes from Gonaives. There have been reports that one of the first two cholera victims in the region, when being shut out by the clinic and the community, deliberately polluted the drinking water source in Kay Felip, causing the other three people (of the initial five people) to contract cholera. There is a lot of panic and fear as a result, which could all easily be assuaged with the presence of a qualified doctor or nurse and some cholera medical supplies. A29 is currently engaged in efforts to secure supplies and transport for cholera treatment from PAP but has met with great challenges thus far. A29 is also attempting to engage medical teams to bring support to the region, which almost never receives such assistance because of its isolated location NW of Gonaives. -> 11/4/10 Email from Dr. Grazia Caleo, PAHO Gonaive I am based in Gonaive for PAHO/OMS. I am following the alert situation in the Haut Artibonite. Regarding the situation in Anse Rouge I contacted MSF France they told me that in Source Chaude they set up a UTC in Anse Rouge a points ORS. Also they regularly provide support and supply. (LPar Note: Amber is contacting MSF to coord. and clarify what their support will be. Supply drop was noted in 12/2/10 entry. Staff support needs to be clarified.) ---------------------------------------------- 12/2/10: From conversation with Amber Market days are twice a week Thurs. and Sat. Missionary Air Sities uses airstrip. We were also able to hook them up with CARE for educational materials! Herbert has a meeting with them set up. ------------------------------------------------- 12/2/10 Email from Amber Munger ...still waiting for verifiable information. The volunteer nurse auxiliary in the La Source Chaude Clinic is refusing to give A29 or the community health committee information on cholera patients because we won't provide him with a salary or other means of compensation. As I mentioned before, the nurse auxiliary is a volunteer that does not have a good relationship with the community but is the only medical personnel that the community has. The Communal Director for MSPP (Dr. Carlo) is meeting with the community health committee, community leadership council, A29, and the nurse auxiliary on Friday to resolve the issue. A29's coordinator, Hebert Pierre, at this point can only verify the number of patients that he has seen at the clinic while he has been present in La Source for the last week. In general, the La Source Chaude clinic has had about 15-19 overnight cholera patients per day for the last five days at the CTC. We can confirm, too, that MSF brought 9 boxes of supplies, (presumably hydration fluid) (this is in addition to a large tent and small amt. of supplies that MSPP dropped off after 63 patients were transported)to the La Source Chaude clinic yesterday. After the meeting on Friday I will be able to give an inventory report on what was given. In terms of the Town of Anse Rouge, as I mentioned before, Hebert said that that clinic is closed. When he went to the clinic again on Tuesday to get information there was only a guardian there who could not provide him with any information. He is hoping to establish more formalised lines of communication today and tomorrow as he meets with CARE - who contacted him yesterday - and MSPP on Friday at the community meeting. ------------------------------------------- 11/22/10 Notes from Amber Hebert has not yet even met with the organization in PAP to know what supplies we will get . That appointment is at 10:00 today. The we still ahve to figure out transport for the supplies. As soon as we receive supplies I will let you know. These supplies will be for the La SOurce Chaude clinic FIRST and anything we can spare we will give to teh CIty Clinic. The City Clinic is on Route National One and patients can more easily find transport to Gonaives from that Center. That is not the case where we are in La SOurce Chaude. We need to have supplies at the La SOurce Chaude clinic because those people will not be able to make it to another location easily. It was a blessing that MSPP had a truck available to send to La Source last time. I dont think our luck wil be the same next time around. Water - the La Source Chaude clinic has water as we have hot springs in la Source Chaude (which means, in French, "hot spring"). The nurse auxillary who works there is highly incompetent and does not use the water filter that was set up for the clinic because he does not like the person who installed it. If he decided to use it again it has to be reinstalled and will be at least a few weeks before it is up and running. So we need aquatab or other water disinfectant for the clinic (as well as for the population in general). ---------------------------------------------- 11/21/10 Update on Assessment from Amber Munger When did cholera patients begin to come at this location? 9 or 10 November How many people does your facility serve? There are approximately 37,000 people in Commune Anse Rouge. Normally, the La SOurce Chaude clinic services about 1/6 of the population. Now that all other clinics except the one in the City of Anse Rouge have closed, people are coming from throughout the commune to the La Source Chaude clinic. Current Cholera Patient Load Up until November 18th there were only five cases (all of whom died). However, yesterday 63 patients walked or were transported to the La Source Chaude clinic many of them walking from extremely remote locations where they were expected to have brought cholera from Port-de-Paix. Most of the patients were coming from Tante, Yaya and Bonsinye, extremely high mountain regions that border third section Port-de-Paix. Fatality Rate for Cholera? Five of the five patients who had cholera until November 18th died; one is suspected of intentionally polluting the water source when he was shut out of the clinics, spreading cholera to three other people in the village of Kay Felip. Yesterday, November 20th one patient died and then 63 more people proceeded arrive at teh clinic. These people were transported in a MSPP truck to Gonaives. No one died en route but we are unclear as to what happened after they were deposited in Gonaives. Has number of patients stabilized? Today there were only seven patients in total. Yesterday was market day and people came from very far to the La Source market, explaining the huge increase in numbers. Medical Staffing (eg. no. of Doctors, no. of Nurses, no. of non medical staff): The community health clinic has no paid staff. There is only a volunteer nurse auxillary at the clinic. There are no qualified medical proffessionals (doctors or nurses) in the entire second section Commune Anse Rouge and only one that we know of in the first section. How many patients are you treating daily? Will update in a few days. How many hospitalized? Just transported all patients Does your facility provide Mobile Medical Clinics to the community?we do not have transportation available What is your Cholera Bed Capacity? There were only five beds in the La SOurce clinic. MSPP sent a tent for the clinic to set up in the lakou but have not provided beds. Describe accessibility to your site (e.g. Passable roads? Helicopter Landing Pad or spot? Airstrip for small planes? Please provide conditions for air landings and GPS coordinates). By road, it is a 2 hour trip from Gonaives (one hour on route national one and another hour on teh road from Letan to La Source Chaude). It is a very difficult road, even by Haiti standards. There is a helicopter landing strip in the City of Anse Rouge, which is a one hour drive from La Source Chaude, but is a much easier drive than the trip from Gonaives. Can you pick up supplies? We can pay local trucks to retrieve the supplies. THe local leaders in the community will offer the use of their large transport vehicles. Medical Supply needs (List by PRIORITY please). cholera related supplies and disinfectants. The clinic is also lacking in basic antibiotics for most other treatable illnesses. ---------------------------------------- 11/21/10 Email from Amber Hi folks - Just a quick update on this. Yesterday 63 patients showed up at the La Sources Chaude clinic after noon because all other clinics in Commune Anse Rouge (except for the one in the City of Anse Rouge) closed their doors to cholera patients. A29 Coordinator lobbied MSPP in Gonaives for help. In response, MSPP sent a truck to La Source Chaude to transport the 63 patients to Gonaives. Our coordinator said there were only a few patients who came to the La Source Clinic this morning before he left for PAP to try to seek medical supplies. MSPP sent us some fluid and IVs as well as a tent to set up a CTC in the lakou of the La Sous Clinic. The supplies will not last long. Hebert is in PAP meeting with Americare to see if they would be willing to give us free antibiotics, fluids, clorox for disinfecting the center, and aquatab. As I mentioned before, there are no qualified medical personnel in second section Commune Anse Rouge, and I am not sure that there are any either in the first section either (other than the regional director, who is helping to coordinate rather than see patients). ----------------------------------------- 11/21/10 Email from Amber I am on a call until 8:00 when I will get back to this but for now I wanted to make clear that A29 does not represent the ILODEP clinic. A29 is trying to find support for the community clinics - not the private clinic run by a private organization. I just received word that even the ILODEP clinic closed, just as all of the other private clinics. The private clinics will not accept cholera patients. Since I last wrote you yesterday, the La SOurce Chaude clinic received 63 patients - because all of the other clinics in the entire commune closed except for the City of Anse Rouge clinic which has no materials. Since the La SOurce Chaude clinic also had no materials, our coordinator Hebert Pierre worked with the Ministry of Health to try to find transport to Gonaives for all 63 of the patients. Gonaives is a treacherous two hour drive from La Source Chaude, and not many vehicles make the voyage. I will fill out the information on the sheet that you sent me just as soon as I am off the call with my board. Thanks for your help! ------------------------------------------- 11/21/10 Have requested Assesment information from Amber for clinic. lpar ------------------------------------------- Email from Amber Munger of Article 29 Organization 11/21/10 Commune Anse Rouge has approximately 37,000 residents but also services parts of Terre Neuve, raising the number to about 42,000. Article 29 Organization's base is in Second Section Commune Anse Rouge, which has four physical health clinics. One is the ILODEP clinic sponsored by Parole et Action, the other three are community clinics which have no paid staff and have not received supplies since July, the last time that A29 secured supplies for distribution to the clinics. There is no doctor or nurse in second section Commune Anse Rouge. There is rumored to be a doctor present in the City of Anse Rouge at the tent clinic (in first section Commune Anse Rouge) at the site of the old hospital that burnt down last year. This clinic is between a 2 to 8 hour walk for people in Second Section Commune Anse Rouge and there are virtually no taptaps or cars in the region. Cholera first entered Second Section Commune Anse Rouge about two weeks ago with cases coming in from people who had been in Gonaives. In second Section Commune Anse Rouge, we had five cases last week. The La Source Chaude clinic, which is the main clinic for the second section and is run by a volunteer nurse auxillary, closed its doors for fear of cholera. All five cholera victims died. A29's coordinator lobbied regional MSPP to re-open the clinic, which the volunteer nurse auxillary has now done, but there are currently no supplies (IV's, hydration fluids, antibiotics) to treat patients. Thus, more patients have arrived at the clinic, receive a cholera diagnosis, and then die. By the time the patients arrive at the clinic they have been too far along to respond to ORS, so IVs are needed. There are very few cars in the region so it is difficult to get patients to the City of Anse Rouge clinic, which as of yesterday was also out of IVs and rehydration fluids. As of yesterday, at least five more cholera patients found transport from SEcond Section Commune Anse Rouge to the City of Anse Rouge clinic in the first section. Two more died at the La Source Chaude clinic in Second Section. Five new patients had arrived at the La Source Clinic yesterday. A29 launched a public education and prevention campaign two weeks ago at teh regions two largest public markets (the City of Anse Rouge and the La Source Chaude markets). Information is spread by megaphone regarding prevention of cholera, treatment and how and when to make ORS. As a result of the outbreak in Gonaives, people are afraid to go to Gonaives for fear of contracting cholera. This puts the entire region in a precarious position as most of the region's supplies are procured in Gonaives (rice, oil, gas, everything). Commune Anse Rouge produces shallot and sourghum and pwa congo but no other crops in sufficient quantity to meet people's basic dietary needs - everything comes from Gonaives. There have been reports that one of the first two cholera victims in the region, when being shut out by the clinic and the community, deliberately polluted the drinking water source in Kay Felip, causing the other three people (of the initial five people) to contract cholera. There is a lot of panic and fear as a result, which could all easily be assuaged with the presence of a qualified doctor or nurse and some cholera medical supplies. A29 is currently engaged in efforts to secure supplies and transport for cholera treatment from PAP but has met with great challenges thus far. A29 is also attempting to engage medical teams to bring support to the region, which almost never receives such assistance because of its isolated location NW of Gonaives.
other_contacts changed.

notes: 12/2/10: From HEAS Post from Amber Munger There remain 18 patients in the La Source Chaude Clinic today. The population of cholera overnight patients has been stable at 18 for the last three days. The center has had no more than 19 cholera patients per day since the surge of 63 patients that entered the clinic on November 20th. At some time within the last two days, one cholera patient from Poin des Manges arrived at teh cholera clinic but died before he was helped. Dr. Carlo from MSPP came to the clinic today and ordered the nurse auxiliary to allow the health committee and A29 to take an inventory of medications and materials in the clinic and to report to the committee the essential data (including patient load) each day. The nurse auxiliary had previously refused to give information on the center or its supplies due to a community conflict. The clinic is scheduled to be inventoried by Article 29 Organization and the health committee tomorrow. Article 29 Organization was able to secure some supplies for the clinic from AMERICARE in PAP. MSF also sent supplies sometime within the last few days. Correction to an earlier email - MSF has delivered supplies to this clinic and provided one nurse who staffed the clinic for one week ending last week. I earlier reported that the nurse was sent by MSPP. What I am hearing now is that MSPP sent a few other people to help with setup in the clinic, but that MSF sent the nurse. All left after one week. Article 29 has photos of the supplies sent by AMERICARE and the recent delivery by MSF as well as the set up of the CTC in Source Chaude. If you would like copies of the photos please let us know. ---------------------------------------------- 12/2/10: From conversation with Amber Market days are twice a week Thurs. and Sat. Missionary Air Sities uses airstrip. We were also able to hook them up with CARE for educational materials! Herbert has a meeting with them set up. ------------------------------------------------- 12/2/10 Email from Amber Munger ...still waiting for verifiable information. The volunteer nurse auxiliary in the La Source Chaude Clinic is refusing to give A29 or the community health committee information on cholera patients because we won't provide him with a salary or other means of compensation. As I mentioned before, the nurse auxiliary is a volunteer that does not have a good relationship with the community but is the only medical personnel that the community has. The Communal Director for MSPP (Dr. Carlo) is meeting with the community health committee, community leadership council, A29, and the nurse auxiliary on Friday to resolve the issue. A29's coordinator, Hebert Pierre, at this point can only verify the number of patients that he has seen at the clinic while he has been present in La Source for the last week. In general, the La Source Chaude clinic has had about 15-19 overnight cholera patients per day for the last five days at the CTC. We can confirm, too, that MSF brought 9 boxes of supplies, (presumably hydration fluid) (this is in addition to a large tent and small amt. of supplies that MSPP dropped off after 63 patients were transported)to the La Source Chaude clinic yesterday. After the meeting on Friday I will be able to give an inventory report on what was given. In terms of the Town of Anse Rouge, as I mentioned before, Hebert said that that clinic is closed. When he went to the clinic again on Tuesday to get information there was only a guardian there who could not provide him with any information. He is hoping to establish more formalised lines of communication today and tomorrow as he meets with CARE - who contacted him yesterday - and MSPP on Friday at the community meeting. ------------------------------------------- 11/22/10 Notes from Amber Hebert has not yet even met with the organization in PAP to know what supplies we will get . That appointment is at 10:00 today. The we still ahve to figure out transport for the supplies. As soon as we receive supplies I will let you know. These supplies will be for the La SOurce Chaude clinic FIRST and anything we can spare we will give to teh CIty Clinic. The City Clinic is on Route National One and patients can more easily find transport to Gonaives from that Center. That is not the case where we are in La SOurce Chaude. We need to have supplies at the La SOurce Chaude clinic because those people will not be able to make it to another location easily. It was a blessing that MSPP had a truck available to send to La Source last time. I dont think our luck wil be the same next time around. Water - the La Source Chaude clinic has water as we have hot springs in la Source Chaude (which means, in French, "hot spring"). The nurse auxillary who works there is highly incompetent and does not use the water filter that was set up for the clinic because he does not like the person who installed it. If he decided to use it again it has to be reinstalled and will be at least a few weeks before it is up and running. So we need aquatab or other water disinfectant for the clinic (as well as for the population in general). ---------------------------------------------- 11/21/10 Update on Assessment from Amber Munger When did cholera patients begin to come at this location? 9 or 10 November How many people does your facility serve? There are approximately 37,000 people in Commune Anse Rouge. Normally, the La SOurce Chaude clinic services about 1/6 of the population. Now that all other clinics except the one in the City of Anse Rouge have closed, people are coming from throughout the commune to the La Source Chaude clinic. Current Cholera Patient Load Up until November 18th there were only five cases (all of whom died). However, yesterday 63 patients walked or were transported to the La Source Chaude clinic many of them walking from extremely remote locations where they were expected to have brought cholera from Port-de-Paix. Most of the patients were coming from Tante, Yaya and Bonsinye, extremely high mountain regions that border third section Port-de-Paix. Fatality Rate for Cholera? Five of the five patients who had cholera until November 18th died; one is suspected of intentionally polluting the water source when he was shut out of the clinics, spreading cholera to three other people in the village of Kay Felip. Yesterday, November 20th one patient died and then 63 more people proceeded arrive at teh clinic. These people were transported in a MSPP truck to Gonaives. No one died en route but we are unclear as to what happened after they were deposited in Gonaives. Has number of patients stabilized? Today there were only seven patients in total. Yesterday was market day and people came from very far to the La Source market, explaining the huge increase in numbers. Medical Staffing (eg. no. of Doctors, no. of Nurses, no. of non medical staff): The community health clinic has no paid staff. There is only a volunteer nurse auxillary at the clinic. There are no qualified medical proffessionals (doctors or nurses) in the entire second section Commune Anse Rouge and only one that we know of in the first section. How many patients are you treating daily? Will update in a few days. How many hospitalized? Just transported all patients Does your facility provide Mobile Medical Clinics to the community?we do not have transportation available What is your Cholera Bed Capacity? There were only five beds in the La SOurce clinic. MSPP sent a tent for the clinic to set up in the lakou but have not provided beds. Describe accessibility to your site (e.g. Passable roads? Helicopter Landing Pad or spot? Airstrip for small planes? Please provide conditions for air landings and GPS coordinates). By road, it is a 2 hour trip from Gonaives (one hour on route national one and another hour on teh road from Letan to La Source Chaude). It is a very difficult road, even by Haiti standards. There is a helicopter landing strip in the City of Anse Rouge, which is a one hour drive from La Source Chaude, but is a much easier drive than the trip from Gonaives. Can you pick up supplies? We can pay local trucks to retrieve the supplies. THe local leaders in the community will offer the use of their large transport vehicles. Medical Supply needs (List by PRIORITY please). cholera related supplies and disinfectants. The clinic is also lacking in basic antibiotics for most other treatable illnesses. ---------------------------------------- 11/21/10 Email from Amber Hi folks - Just a quick update on this. Yesterday 63 patients showed up at the La Sources Chaude clinic after noon because all other clinics in Commune Anse Rouge (except for the one in the City of Anse Rouge) closed their doors to cholera patients. A29 Coordinator lobbied MSPP in Gonaives for help. In response, MSPP sent a truck to La Source Chaude to transport the 63 patients to Gonaives. Our coordinator said there were only a few patients who came to the La Source Clinic this morning before he left for PAP to try to seek medical supplies. MSPP sent us some fluid and IVs as well as a tent to set up a CTC in the lakou of the La Sous Clinic. The supplies will not last long. Hebert is in PAP meeting with Americare to see if they would be willing to give us free antibiotics, fluids, clorox for disinfecting the center, and aquatab. As I mentioned before, there are no qualified medical personnel in second section Commune Anse Rouge, and I am not sure that there are any either in the first section either (other than the regional director, who is helping to coordinate rather than see patients). ----------------------------------------- 11/21/10 Email from Amber I am on a call until 8:00 when I will get back to this but for now I wanted to make clear that A29 does not represent the ILODEP clinic. A29 is trying to find support for the community clinics - not the private clinic run by a private organization. I just received word that even the ILODEP clinic closed, just as all of the other private clinics. The private clinics will not accept cholera patients. Since I last wrote you yesterday, the La SOurce Chaude clinic received 63 patients - because all of the other clinics in the entire commune closed except for the City of Anse Rouge clinic which has no materials. Since the La SOurce Chaude clinic also had no materials, our coordinator Hebert Pierre worked with the Ministry of Health to try to find transport to Gonaives for all 63 of the patients. Gonaives is a treacherous two hour drive from La Source Chaude, and not many vehicles make the voyage. I will fill out the information on the sheet that you sent me just as soon as I am off the call with my board. Thanks for your help! ------------------------------------------- 11/21/10 Have requested Assesment information from Amber for clinic. lpar ------------------------------------------- Email from Amber Munger of Article 29 Organization 11/21/10 Commune Anse Rouge has approximately 37,000 residents but also services parts of Terre Neuve, raising the number to about 42,000. Article 29 Organization's base is in Second Section Commune Anse Rouge, which has four physical health clinics. One is the ILODEP clinic sponsored by Parole et Action, the other three are community clinics which have no paid staff and have not received supplies since July, the last time that A29 secured supplies for distribution to the clinics. There is no doctor or nurse in second section Commune Anse Rouge. There is rumored to be a doctor present in the City of Anse Rouge at the tent clinic (in first section Commune Anse Rouge) at the site of the old hospital that burnt down last year. This clinic is between a 2 to 8 hour walk for people in Second Section Commune Anse Rouge and there are virtually no taptaps or cars in the region. Cholera first entered Second Section Commune Anse Rouge about two weeks ago with cases coming in from people who had been in Gonaives. In second Section Commune Anse Rouge, we had five cases last week. The La Source Chaude clinic, which is the main clinic for the second section and is run by a volunteer nurse auxillary, closed its doors for fear of cholera. All five cholera victims died. A29's coordinator lobbied regional MSPP to re-open the clinic, which the volunteer nurse auxillary has now done, but there are currently no supplies (IV's, hydration fluids, antibiotics) to treat patients. Thus, more patients have arrived at the clinic, receive a cholera diagnosis, and then die. By the time the patients arrive at the clinic they have been too far along to respond to ORS, so IVs are needed. There are very few cars in the region so it is difficult to get patients to the City of Anse Rouge clinic, which as of yesterday was also out of IVs and rehydration fluids. As of yesterday, at least five more cholera patients found transport from SEcond Section Commune Anse Rouge to the City of Anse Rouge clinic in the first section. Two more died at the La Source Chaude clinic in Second Section. Five new patients had arrived at the La Source Clinic yesterday. A29 launched a public education and prevention campaign two weeks ago at teh regions two largest public markets (the City of Anse Rouge and the La Source Chaude markets). Information is spread by megaphone regarding prevention of cholera, treatment and how and when to make ORS. As a result of the outbreak in Gonaives, people are afraid to go to Gonaives for fear of contracting cholera. This puts the entire region in a precarious position as most of the region's supplies are procured in Gonaives (rice, oil, gas, everything). Commune Anse Rouge produces shallot and sourghum and pwa congo but no other crops in sufficient quantity to meet people's basic dietary needs - everything comes from Gonaives. There have been reports that one of the first two cholera victims in the region, when being shut out by the clinic and the community, deliberately polluted the drinking water source in Kay Felip, causing the other three people (of the initial five people) to contract cholera. There is a lot of panic and fear as a result, which could all easily be assuaged with the presence of a qualified doctor or nurse and some cholera medical supplies. A29 is currently engaged in efforts to secure supplies and transport for cholera treatment from PAP but has met with great challenges thus far. A29 is also attempting to engage medical teams to bring support to the region, which almost never receives such assistance because of its isolated location NW of Gonaives. -> 12/2/10: From conversation with Amber Market days are twice a week Thurs. and Sat. Missionary Air Sities uses airstrip. We were also able to hook them up with CARE for educational materials! Herbert has a meeting with them set up. ------------------------------------------------- 12/2/10 Email from Amber Munger ...still waiting for verifiable information. The volunteer nurse auxiliary in the La Source Chaude Clinic is refusing to give A29 or the community health committee information on cholera patients because we won't provide him with a salary or other means of compensation. As I mentioned before, the nurse auxiliary is a volunteer that does not have a good relationship with the community but is the only medical personnel that the community has. The Communal Director for MSPP (Dr. Carlo) is meeting with the community health committee, community leadership council, A29, and the nurse auxiliary on Friday to resolve the issue. A29's coordinator, Hebert Pierre, at this point can only verify the number of patients that he has seen at the clinic while he has been present in La Source for the last week. In general, the La Source Chaude clinic has had about 15-19 overnight cholera patients per day for the last five days at the CTC. We can confirm, too, that MSF brought 9 boxes of supplies, (presumably hydration fluid) (this is in addition to a large tent and small amt. of supplies that MSPP dropped off after 63 patients were transported)to the La Source Chaude clinic yesterday. After the meeting on Friday I will be able to give an inventory report on what was given. In terms of the Town of Anse Rouge, as I mentioned before, Hebert said that that clinic is closed. When he went to the clinic again on Tuesday to get information there was only a guardian there who could not provide him with any information. He is hoping to establish more formalised lines of communication today and tomorrow as he meets with CARE - who contacted him yesterday - and MSPP on Friday at the community meeting. ------------------------------------------- 11/22/10 Notes from Amber Hebert has not yet even met with the organization in PAP to know what supplies we will get . That appointment is at 10:00 today. The we still ahve to figure out transport for the supplies. As soon as we receive supplies I will let you know. These supplies will be for the La SOurce Chaude clinic FIRST and anything we can spare we will give to teh CIty Clinic. The City Clinic is on Route National One and patients can more easily find transport to Gonaives from that Center. That is not the case where we are in La SOurce Chaude. We need to have supplies at the La SOurce Chaude clinic because those people will not be able to make it to another location easily. It was a blessing that MSPP had a truck available to send to La Source last time. I dont think our luck wil be the same next time around. Water - the La Source Chaude clinic has water as we have hot springs in la Source Chaude (which means, in French, "hot spring"). The nurse auxillary who works there is highly incompetent and does not use the water filter that was set up for the clinic because he does not like the person who installed it. If he decided to use it again it has to be reinstalled and will be at least a few weeks before it is up and running. So we need aquatab or other water disinfectant for the clinic (as well as for the population in general). ---------------------------------------------- 11/21/10 Update on Assessment from Amber Munger When did cholera patients begin to come at this location? 9 or 10 November How many people does your facility serve? There are approximately 37,000 people in Commune Anse Rouge. Normally, the La SOurce Chaude clinic services about 1/6 of the population. Now that all other clinics except the one in the City of Anse Rouge have closed, people are coming from throughout the commune to the La Source Chaude clinic. Current Cholera Patient Load Up until November 18th there were only five cases (all of whom died). However, yesterday 63 patients walked or were transported to the La Source Chaude clinic many of them walking from extremely remote locations where they were expected to have brought cholera from Port-de-Paix. Most of the patients were coming from Tante, Yaya and Bonsinye, extremely high mountain regions that border third section Port-de-Paix. Fatality Rate for Cholera? Five of the five patients who had cholera until November 18th died; one is suspected of intentionally polluting the water source when he was shut out of the clinics, spreading cholera to three other people in the village of Kay Felip. Yesterday, November 20th one patient died and then 63 more people proceeded arrive at teh clinic. These people were transported in a MSPP truck to Gonaives. No one died en route but we are unclear as to what happened after they were deposited in Gonaives. Has number of patients stabilized? Today there were only seven patients in total. Yesterday was market day and people came from very far to the La Source market, explaining the huge increase in numbers. Medical Staffing (eg. no. of Doctors, no. of Nurses, no. of non medical staff): The community health clinic has no paid staff. There is only a volunteer nurse auxillary at the clinic. There are no qualified medical proffessionals (doctors or nurses) in the entire second section Commune Anse Rouge and only one that we know of in the first section. How many patients are you treating daily? Will update in a few days. How many hospitalized? Just transported all patients Does your facility provide Mobile Medical Clinics to the community?we do not have transportation available What is your Cholera Bed Capacity? There were only five beds in the La SOurce clinic. MSPP sent a tent for the clinic to set up in the lakou but have not provided beds. Describe accessibility to your site (e.g. Passable roads? Helicopter Landing Pad or spot? Airstrip for small planes? Please provide conditions for air landings and GPS coordinates). By road, it is a 2 hour trip from Gonaives (one hour on route national one and another hour on teh road from Letan to La Source Chaude). It is a very difficult road, even by Haiti standards. There is a helicopter landing strip in the City of Anse Rouge, which is a one hour drive from La Source Chaude, but is a much easier drive than the trip from Gonaives. Can you pick up supplies? We can pay local trucks to retrieve the supplies. THe local leaders in the community will offer the use of their large transport vehicles. Medical Supply needs (List by PRIORITY please). cholera related supplies and disinfectants. The clinic is also lacking in basic antibiotics for most other treatable illnesses. ---------------------------------------- 11/21/10 Email from Amber Hi folks - Just a quick update on this. Yesterday 63 patients showed up at the La Sources Chaude clinic after noon because all other clinics in Commune Anse Rouge (except for the one in the City of Anse Rouge) closed their doors to cholera patients. A29 Coordinator lobbied MSPP in Gonaives for help. In response, MSPP sent a truck to La Source Chaude to transport the 63 patients to Gonaives. Our coordinator said there were only a few patients who came to the La Source Clinic this morning before he left for PAP to try to seek medical supplies. MSPP sent us some fluid and IVs as well as a tent to set up a CTC in the lakou of the La Sous Clinic. The supplies will not last long. Hebert is in PAP meeting with Americare to see if they would be willing to give us free antibiotics, fluids, clorox for disinfecting the center, and aquatab. As I mentioned before, there are no qualified medical personnel in second section Commune Anse Rouge, and I am not sure that there are any either in the first section either (other than the regional director, who is helping to coordinate rather than see patients). ----------------------------------------- 11/21/10 Email from Amber I am on a call until 8:00 when I will get back to this but for now I wanted to make clear that A29 does not represent the ILODEP clinic. A29 is trying to find support for the community clinics - not the private clinic run by a private organization. I just received word that even the ILODEP clinic closed, just as all of the other private clinics. The private clinics will not accept cholera patients. Since I last wrote you yesterday, the La SOurce Chaude clinic received 63 patients - because all of the other clinics in the entire commune closed except for the City of Anse Rouge clinic which has no materials. Since the La SOurce Chaude clinic also had no materials, our coordinator Hebert Pierre worked with the Ministry of Health to try to find transport to Gonaives for all 63 of the patients. Gonaives is a treacherous two hour drive from La Source Chaude, and not many vehicles make the voyage. I will fill out the information on the sheet that you sent me just as soon as I am off the call with my board. Thanks for your help! ------------------------------------------- 11/21/10 Have requested Assesment information from Amber for clinic. lpar ------------------------------------------- Email from Amber Munger of Article 29 Organization 11/21/10 Commune Anse Rouge has approximately 37,000 residents but also services parts of Terre Neuve, raising the number to about 42,000. Article 29 Organization's base is in Second Section Commune Anse Rouge, which has four physical health clinics. One is the ILODEP clinic sponsored by Parole et Action, the other three are community clinics which have no paid staff and have not received supplies since July, the last time that A29 secured supplies for distribution to the clinics. There is no doctor or nurse in second section Commune Anse Rouge. There is rumored to be a doctor present in the City of Anse Rouge at the tent clinic (in first section Commune Anse Rouge) at the site of the old hospital that burnt down last year. This clinic is between a 2 to 8 hour walk for people in Second Section Commune Anse Rouge and there are virtually no taptaps or cars in the region. Cholera first entered Second Section Commune Anse Rouge about two weeks ago with cases coming in from people who had been in Gonaives. In second Section Commune Anse Rouge, we had five cases last week. The La Source Chaude clinic, which is the main clinic for the second section and is run by a volunteer nurse auxillary, closed its doors for fear of cholera. All five cholera victims died. A29's coordinator lobbied regional MSPP to re-open the clinic, which the volunteer nurse auxillary has now done, but there are currently no supplies (IV's, hydration fluids, antibiotics) to treat patients. Thus, more patients have arrived at the clinic, receive a cholera diagnosis, and then die. By the time the patients arrive at the clinic they have been too far along to respond to ORS, so IVs are needed. There are very few cars in the region so it is difficult to get patients to the City of Anse Rouge clinic, which as of yesterday was also out of IVs and rehydration fluids. As of yesterday, at least five more cholera patients found transport from SEcond Section Commune Anse Rouge to the City of Anse Rouge clinic in the first section. Two more died at the La Source Chaude clinic in Second Section. Five new patients had arrived at the La Source Clinic yesterday. A29 launched a public education and prevention campaign two weeks ago at teh regions two largest public markets (the City of Anse Rouge and the La Source Chaude markets). Information is spread by megaphone regarding prevention of cholera, treatment and how and when to make ORS. As a result of the outbreak in Gonaives, people are afraid to go to Gonaives for fear of contracting cholera. This puts the entire region in a precarious position as most of the region's supplies are procured in Gonaives (rice, oil, gas, everything). Commune Anse Rouge produces shallot and sourghum and pwa congo but no other crops in sufficient quantity to meet people's basic dietary needs - everything comes from Gonaives. There have been reports that one of the first two cholera victims in the region, when being shut out by the clinic and the community, deliberately polluted the drinking water source in Kay Felip, causing the other three people (of the initial five people) to contract cholera. There is a lot of panic and fear as a result, which could all easily be assuaged with the presence of a qualified doctor or nurse and some cholera medical supplies. A29 is currently engaged in efforts to secure supplies and transport for cholera treatment from PAP but has met with great challenges thus far. A29 is also attempting to engage medical teams to bring support to the region, which almost never receives such assistance because of its isolated location NW of Gonaives.
other_contacts changed.

notes: 12/2/10: From conversation with Amber Market days are twice a week Thurs. and Sat. Missionary Air Sities uses airstrip. We were also able to hook them up with CARE for educational materials! Herbert has a meeting with them set up. ------------------------------------------------- 12/2/10 Email from Amber Munger ...still waiting for verifiable information. The volunteer nurse auxiliary in the La Source Chaude Clinic is refusing to give A29 or the community health committee information on cholera patients because we won't provide him with a salary or other means of compensation. As I mentioned before, the nurse auxiliary is a volunteer that does not have a good relationship with the community but is the only medical personnel that the community has. The Communal Director for MSPP (Dr. Carlo) is meeting with the community health committee, community leadership council, A29, and the nurse auxiliary on Friday to resolve the issue. A29's coordinator, Hebert Pierre, at this point can only verify the number of patients that he has seen at the clinic while he has been present in La Source for the last week. In general, the La Source Chaude clinic has had about 15-19 overnight cholera patients per day for the last five days at the CTC. We can confirm, too, that MSF brought 9 boxes of supplies, (presumably hydration fluid) (this is in addition to a large tent and small amt. of supplies that MSPP dropped off after 63 patients were transported)to the La Source Chaude clinic yesterday. After the meeting on Friday I will be able to give an inventory report on what was given. In terms of the Town of Anse Rouge, as I mentioned before, Hebert said that that clinic is closed. When he went to the clinic again on Tuesday to get information there was only a guardian there who could not provide him with any information. He is hoping to establish more formalised lines of communication today and tomorrow as he meets with CARE - who contacted him yesterday - and MSPP on Friday at the community meeting. ------------------------------------------- 11/22/10 Notes from Amber Hebert has not yet even met with the organization in PAP to know what supplies we will get . That appointment is at 10:00 today. The we still ahve to figure out transport for the supplies. As soon as we receive supplies I will let you know. These supplies will be for the La SOurce Chaude clinic FIRST and anything we can spare we will give to teh CIty Clinic. The City Clinic is on Route National One and patients can more easily find transport to Gonaives from that Center. That is not the case where we are in La SOurce Chaude. We need to have supplies at the La SOurce Chaude clinic because those people will not be able to make it to another location easily. It was a blessing that MSPP had a truck available to send to La Source last time. I dont think our luck wil be the same next time around. Water - the La Source Chaude clinic has water as we have hot springs in la Source Chaude (which means, in French, "hot spring"). The nurse auxillary who works there is highly incompetent and does not use the water filter that was set up for the clinic because he does not like the person who installed it. If he decided to use it again it has to be reinstalled and will be at least a few weeks before it is up and running. So we need aquatab or other water disinfectant for the clinic (as well as for the population in general). ---------------------------------------------- 11/21/10 Update on Assessment from Amber Munger When did cholera patients begin to come at this location? 9 or 10 November How many people does your facility serve? There are approximately 37,000 people in Commune Anse Rouge. Normally, the La SOurce Chaude clinic services about 1/6 of the population. Now that all other clinics except the one in the City of Anse Rouge have closed, people are coming from throughout the commune to the La Source Chaude clinic. Current Cholera Patient Load Up until November 18th there were only five cases (all of whom died). However, yesterday 63 patients walked or were transported to the La Source Chaude clinic many of them walking from extremely remote locations where they were expected to have brought cholera from Port-de-Paix. Most of the patients were coming from Tante, Yaya and Bonsinye, extremely high mountain regions that border third section Port-de-Paix. Fatality Rate for Cholera? Five of the five patients who had cholera until November 18th died; one is suspected of intentionally polluting the water source when he was shut out of the clinics, spreading cholera to three other people in the village of Kay Felip. Yesterday, November 20th one patient died and then 63 more people proceeded arrive at teh clinic. These people were transported in a MSPP truck to Gonaives. No one died en route but we are unclear as to what happened after they were deposited in Gonaives. Has number of patients stabilized? Today there were only seven patients in total. Yesterday was market day and people came from very far to the La Source market, explaining the huge increase in numbers. Medical Staffing (eg. no. of Doctors, no. of Nurses, no. of non medical staff): The community health clinic has no paid staff. There is only a volunteer nurse auxillary at the clinic. There are no qualified medical proffessionals (doctors or nurses) in the entire second section Commune Anse Rouge and only one that we know of in the first section. How many patients are you treating daily? Will update in a few days. How many hospitalized? Just transported all patients Does your facility provide Mobile Medical Clinics to the community?we do not have transportation available What is your Cholera Bed Capacity? There were only five beds in the La SOurce clinic. MSPP sent a tent for the clinic to set up in the lakou but have not provided beds. Describe accessibility to your site (e.g. Passable roads? Helicopter Landing Pad or spot? Airstrip for small planes? Please provide conditions for air landings and GPS coordinates). By road, it is a 2 hour trip from Gonaives (one hour on route national one and another hour on teh road from Letan to La Source Chaude). It is a very difficult road, even by Haiti standards. There is a helicopter landing strip in the City of Anse Rouge, which is a one hour drive from La Source Chaude, but is a much easier drive than the trip from Gonaives. Can you pick up supplies? We can pay local trucks to retrieve the supplies. THe local leaders in the community will offer the use of their large transport vehicles. Medical Supply needs (List by PRIORITY please). cholera related supplies and disinfectants. The clinic is also lacking in basic antibiotics for most other treatable illnesses. ---------------------------------------- 11/21/10 Email from Amber Hi folks - Just a quick update on this. Yesterday 63 patients showed up at the La Sources Chaude clinic after noon because all other clinics in Commune Anse Rouge (except for the one in the City of Anse Rouge) closed their doors to cholera patients. A29 Coordinator lobbied MSPP in Gonaives for help. In response, MSPP sent a truck to La Source Chaude to transport the 63 patients to Gonaives. Our coordinator said there were only a few patients who came to the La Source Clinic this morning before he left for PAP to try to seek medical supplies. MSPP sent us some fluid and IVs as well as a tent to set up a CTC in the lakou of the La Sous Clinic. The supplies will not last long. Hebert is in PAP meeting with Americare to see if they would be willing to give us free antibiotics, fluids, clorox for disinfecting the center, and aquatab. As I mentioned before, there are no qualified medical personnel in second section Commune Anse Rouge, and I am not sure that there are any either in the first section either (other than the regional director, who is helping to coordinate rather than see patients). ----------------------------------------- 11/21/10 Email from Amber I am on a call until 8:00 when I will get back to this but for now I wanted to make clear that A29 does not represent the ILODEP clinic. A29 is trying to find support for the community clinics - not the private clinic run by a private organization. I just received word that even the ILODEP clinic closed, just as all of the other private clinics. The private clinics will not accept cholera patients. Since I last wrote you yesterday, the La SOurce Chaude clinic received 63 patients - because all of the other clinics in the entire commune closed except for the City of Anse Rouge clinic which has no materials. Since the La SOurce Chaude clinic also had no materials, our coordinator Hebert Pierre worked with the Ministry of Health to try to find transport to Gonaives for all 63 of the patients. Gonaives is a treacherous two hour drive from La Source Chaude, and not many vehicles make the voyage. I will fill out the information on the sheet that you sent me just as soon as I am off the call with my board. Thanks for your help! ------------------------------------------- 11/21/10 Have requested Assesment information from Amber for clinic. lpar ------------------------------------------- Email from Amber Munger of Article 29 Organization 11/21/10 Commune Anse Rouge has approximately 37,000 residents but also services parts of Terre Neuve, raising the number to about 42,000. Article 29 Organization's base is in Second Section Commune Anse Rouge, which has four physical health clinics. One is the ILODEP clinic sponsored by Parole et Action, the other three are community clinics which have no paid staff and have not received supplies since July, the last time that A29 secured supplies for distribution to the clinics. There is no doctor or nurse in second section Commune Anse Rouge. There is rumored to be a doctor present in the City of Anse Rouge at the tent clinic (in first section Commune Anse Rouge) at the site of the old hospital that burnt down last year. This clinic is between a 2 to 8 hour walk for people in Second Section Commune Anse Rouge and there are virtually no taptaps or cars in the region. Cholera first entered Second Section Commune Anse Rouge about two weeks ago with cases coming in from people who had been in Gonaives. In second Section Commune Anse Rouge, we had five cases last week. The La Source Chaude clinic, which is the main clinic for the second section and is run by a volunteer nurse auxillary, closed its doors for fear of cholera. All five cholera victims died. A29's coordinator lobbied regional MSPP to re-open the clinic, which the volunteer nurse auxillary has now done, but there are currently no supplies (IV's, hydration fluids, antibiotics) to treat patients. Thus, more patients have arrived at the clinic, receive a cholera diagnosis, and then die. By the time the patients arrive at the clinic they have been too far along to respond to ORS, so IVs are needed. There are very few cars in the region so it is difficult to get patients to the City of Anse Rouge clinic, which as of yesterday was also out of IVs and rehydration fluids. As of yesterday, at least five more cholera patients found transport from SEcond Section Commune Anse Rouge to the City of Anse Rouge clinic in the first section. Two more died at the La Source Chaude clinic in Second Section. Five new patients had arrived at the La Source Clinic yesterday. A29 launched a public education and prevention campaign two weeks ago at teh regions two largest public markets (the City of Anse Rouge and the La Source Chaude markets). Information is spread by megaphone regarding prevention of cholera, treatment and how and when to make ORS. As a result of the outbreak in Gonaives, people are afraid to go to Gonaives for fear of contracting cholera. This puts the entire region in a precarious position as most of the region's supplies are procured in Gonaives (rice, oil, gas, everything). Commune Anse Rouge produces shallot and sourghum and pwa congo but no other crops in sufficient quantity to meet people's basic dietary needs - everything comes from Gonaives. There have been reports that one of the first two cholera victims in the region, when being shut out by the clinic and the community, deliberately polluted the drinking water source in Kay Felip, causing the other three people (of the initial five people) to contract cholera. There is a lot of panic and fear as a result, which could all easily be assuaged with the presence of a qualified doctor or nurse and some cholera medical supplies. A29 is currently engaged in efforts to secure supplies and transport for cholera treatment from PAP but has met with great challenges thus far. A29 is also attempting to engage medical teams to bring support to the region, which almost never receives such assistance because of its isolated location NW of Gonaives. -> 12/2/10: From HEAS Post from Amber Munger There remain 18 patients in the La Source Chaude Clinic today. The population of cholera overnight patients has been stable at 18 for the last three days. The center has had no more than 19 cholera patients per day since the surge of 63 patients that entered the clinic on November 20th. At some time within the last two days, one cholera patient from Poin des Manges arrived at teh cholera clinic but died before he was helped. Dr. Carlo from MSPP came to the clinic today and ordered the nurse auxiliary to allow the health committee and A29 to take an inventory of medications and materials in the clinic and to report to the committee the essential data (including patient load) each day. The nurse auxiliary had previously refused to give information on the center or its supplies due to a community conflict. The clinic is scheduled to be inventoried by Article 29 Organization and the health committee tomorrow. Article 29 Organization was able to secure some supplies for the clinic from AMERICARE in PAP. MSF also sent supplies sometime within the last few days. Correction to an earlier email - MSF has delivered supplies to this clinic and provided one nurse who staffed the clinic for one week ending last week. I earlier reported that the nurse was sent by MSPP. What I am hearing now is that MSPP sent a few other people to help with setup in the clinic, but that MSF sent the nurse. All left after one week. Article 29 has photos of the supplies sent by AMERICARE and the recent delivery by MSF as well as the set up of the CTC in Source Chaude. If you would like copies of the photos please let us know. ---------------------------------------------- 12/2/10: From conversation with Amber Market days are twice a week Thurs. and Sat. Missionary Air Sities uses airstrip. We were also able to hook them up with CARE for educational materials! Herbert has a meeting with them set up. ------------------------------------------------- 12/2/10 Email from Amber Munger ...still waiting for verifiable information. The volunteer nurse auxiliary in the La Source Chaude Clinic is refusing to give A29 or the community health committee information on cholera patients because we won't provide him with a salary or other means of compensation. As I mentioned before, the nurse auxiliary is a volunteer that does not have a good relationship with the community but is the only medical personnel that the community has. The Communal Director for MSPP (Dr. Carlo) is meeting with the community health committee, community leadership council, A29, and the nurse auxiliary on Friday to resolve the issue. A29's coordinator, Hebert Pierre, at this point can only verify the number of patients that he has seen at the clinic while he has been present in La Source for the last week. In general, the La Source Chaude clinic has had about 15-19 overnight cholera patients per day for the last five days at the CTC. We can confirm, too, that MSF brought 9 boxes of supplies, (presumably hydration fluid) (this is in addition to a large tent and small amt. of supplies that MSPP dropped off after 63 patients were transported)to the La Source Chaude clinic yesterday. After the meeting on Friday I will be able to give an inventory report on what was given. In terms of the Town of Anse Rouge, as I mentioned before, Hebert said that that clinic is closed. When he went to the clinic again on Tuesday to get information there was only a guardian there who could not provide him with any information. He is hoping to establish more formalised lines of communication today and tomorrow as he meets with CARE - who contacted him yesterday - and MSPP on Friday at the community meeting. ------------------------------------------- 11/22/10 Notes from Amber Hebert has not yet even met with the organization in PAP to know what supplies we will get . That appointment is at 10:00 today. The we still ahve to figure out transport for the supplies. As soon as we receive supplies I will let you know. These supplies will be for the La SOurce Chaude clinic FIRST and anything we can spare we will give to teh CIty Clinic. The City Clinic is on Route National One and patients can more easily find transport to Gonaives from that Center. That is not the case where we are in La SOurce Chaude. We need to have supplies at the La SOurce Chaude clinic because those people will not be able to make it to another location easily. It was a blessing that MSPP had a truck available to send to La Source last time. I dont think our luck wil be the same next time around. Water - the La Source Chaude clinic has water as we have hot springs in la Source Chaude (which means, in French, "hot spring"). The nurse auxillary who works there is highly incompetent and does not use the water filter that was set up for the clinic because he does not like the person who installed it. If he decided to use it again it has to be reinstalled and will be at least a few weeks before it is up and running. So we need aquatab or other water disinfectant for the clinic (as well as for the population in general). ---------------------------------------------- 11/21/10 Update on Assessment from Amber Munger When did cholera patients begin to come at this location? 9 or 10 November How many people does your facility serve? There are approximately 37,000 people in Commune Anse Rouge. Normally, the La SOurce Chaude clinic services about 1/6 of the population. Now that all other clinics except the one in the City of Anse Rouge have closed, people are coming from throughout the commune to the La Source Chaude clinic. Current Cholera Patient Load Up until November 18th there were only five cases (all of whom died). However, yesterday 63 patients walked or were transported to the La Source Chaude clinic many of them walking from extremely remote locations where they were expected to have brought cholera from Port-de-Paix. Most of the patients were coming from Tante, Yaya and Bonsinye, extremely high mountain regions that border third section Port-de-Paix. Fatality Rate for Cholera? Five of the five patients who had cholera until November 18th died; one is suspected of intentionally polluting the water source when he was shut out of the clinics, spreading cholera to three other people in the village of Kay Felip. Yesterday, November 20th one patient died and then 63 more people proceeded arrive at teh clinic. These people were transported in a MSPP truck to Gonaives. No one died en route but we are unclear as to what happened after they were deposited in Gonaives. Has number of patients stabilized? Today there were only seven patients in total. Yesterday was market day and people came from very far to the La Source market, explaining the huge increase in numbers. Medical Staffing (eg. no. of Doctors, no. of Nurses, no. of non medical staff): The community health clinic has no paid staff. There is only a volunteer nurse auxillary at the clinic. There are no qualified medical proffessionals (doctors or nurses) in the entire second section Commune Anse Rouge and only one that we know of in the first section. How many patients are you treating daily? Will update in a few days. How many hospitalized? Just transported all patients Does your facility provide Mobile Medical Clinics to the community?we do not have transportation available What is your Cholera Bed Capacity? There were only five beds in the La SOurce clinic. MSPP sent a tent for the clinic to set up in the lakou but have not provided beds. Describe accessibility to your site (e.g. Passable roads? Helicopter Landing Pad or spot? Airstrip for small planes? Please provide conditions for air landings and GPS coordinates). By road, it is a 2 hour trip from Gonaives (one hour on route national one and another hour on teh road from Letan to La Source Chaude). It is a very difficult road, even by Haiti standards. There is a helicopter landing strip in the City of Anse Rouge, which is a one hour drive from La Source Chaude, but is a much easier drive than the trip from Gonaives. Can you pick up supplies? We can pay local trucks to retrieve the supplies. THe local leaders in the community will offer the use of their large transport vehicles. Medical Supply needs (List by PRIORITY please). cholera related supplies and disinfectants. The clinic is also lacking in basic antibiotics for most other treatable illnesses. ---------------------------------------- 11/21/10 Email from Amber Hi folks - Just a quick update on this. Yesterday 63 patients showed up at the La Sources Chaude clinic after noon because all other clinics in Commune Anse Rouge (except for the one in the City of Anse Rouge) closed their doors to cholera patients. A29 Coordinator lobbied MSPP in Gonaives for help. In response, MSPP sent a truck to La Source Chaude to transport the 63 patients to Gonaives. Our coordinator said there were only a few patients who came to the La Source Clinic this morning before he left for PAP to try to seek medical supplies. MSPP sent us some fluid and IVs as well as a tent to set up a CTC in the lakou of the La Sous Clinic. The supplies will not last long. Hebert is in PAP meeting with Americare to see if they would be willing to give us free antibiotics, fluids, clorox for disinfecting the center, and aquatab. As I mentioned before, there are no qualified medical personnel in second section Commune Anse Rouge, and I am not sure that there are any either in the first section either (other than the regional director, who is helping to coordinate rather than see patients). ----------------------------------------- 11/21/10 Email from Amber I am on a call until 8:00 when I will get back to this but for now I wanted to make clear that A29 does not represent the ILODEP clinic. A29 is trying to find support for the community clinics - not the private clinic run by a private organization. I just received word that even the ILODEP clinic closed, just as all of the other private clinics. The private clinics will not accept cholera patients. Since I last wrote you yesterday, the La SOurce Chaude clinic received 63 patients - because all of the other clinics in the entire commune closed except for the City of Anse Rouge clinic which has no materials. Since the La SOurce Chaude clinic also had no materials, our coordinator Hebert Pierre worked with the Ministry of Health to try to find transport to Gonaives for all 63 of the patients. Gonaives is a treacherous two hour drive from La Source Chaude, and not many vehicles make the voyage. I will fill out the information on the sheet that you sent me just as soon as I am off the call with my board. Thanks for your help! ------------------------------------------- 11/21/10 Have requested Assesment information from Amber for clinic. lpar ------------------------------------------- Email from Amber Munger of Article 29 Organization 11/21/10 Commune Anse Rouge has approximately 37,000 residents but also services parts of Terre Neuve, raising the number to about 42,000. Article 29 Organization's base is in Second Section Commune Anse Rouge, which has four physical health clinics. One is the ILODEP clinic sponsored by Parole et Action, the other three are community clinics which have no paid staff and have not received supplies since July, the last time that A29 secured supplies for distribution to the clinics. There is no doctor or nurse in second section Commune Anse Rouge. There is rumored to be a doctor present in the City of Anse Rouge at the tent clinic (in first section Commune Anse Rouge) at the site of the old hospital that burnt down last year. This clinic is between a 2 to 8 hour walk for people in Second Section Commune Anse Rouge and there are virtually no taptaps or cars in the region. Cholera first entered Second Section Commune Anse Rouge about two weeks ago with cases coming in from people who had been in Gonaives. In second Section Commune Anse Rouge, we had five cases last week. The La Source Chaude clinic, which is the main clinic for the second section and is run by a volunteer nurse auxillary, closed its doors for fear of cholera. All five cholera victims died. A29's coordinator lobbied regional MSPP to re-open the clinic, which the volunteer nurse auxillary has now done, but there are currently no supplies (IV's, hydration fluids, antibiotics) to treat patients. Thus, more patients have arrived at the clinic, receive a cholera diagnosis, and then die. By the time the patients arrive at the clinic they have been too far along to respond to ORS, so IVs are needed. There are very few cars in the region so it is difficult to get patients to the City of Anse Rouge clinic, which as of yesterday was also out of IVs and rehydration fluids. As of yesterday, at least five more cholera patients found transport from SEcond Section Commune Anse Rouge to the City of Anse Rouge clinic in the first section. Two more died at the La Source Chaude clinic in Second Section. Five new patients had arrived at the La Source Clinic yesterday. A29 launched a public education and prevention campaign two weeks ago at teh regions two largest public markets (the City of Anse Rouge and the La Source Chaude markets). Information is spread by megaphone regarding prevention of cholera, treatment and how and when to make ORS. As a result of the outbreak in Gonaives, people are afraid to go to Gonaives for fear of contracting cholera. This puts the entire region in a precarious position as most of the region's supplies are procured in Gonaives (rice, oil, gas, everything). Commune Anse Rouge produces shallot and sourghum and pwa congo but no other crops in sufficient quantity to meet people's basic dietary needs - everything comes from Gonaives. There have been reports that one of the first two cholera victims in the region, when being shut out by the clinic and the community, deliberately polluted the drinking water source in Kay Felip, causing the other three people (of the initial five people) to contract cholera. There is a lot of panic and fear as a result, which could all easily be assuaged with the presence of a qualified doctor or nurse and some cholera medical supplies. A29 is currently engaged in efforts to secure supplies and transport for cholera treatment from PAP but has met with great challenges thus far. A29 is also attempting to engage medical teams to bring support to the region, which almost never receives such assistance because of its isolated location NW of Gonaives.

notes: 12/2/10: From conversation with Amber Market days are twice a week Thurs. and Sat. Missionary Air Sities uses airstrip. We were also able to hook them up with CARE for educational materials! Herbert has a meeting with them set up. ------------------------------------------------- 12/2/10 Email from Amber Munger ...still waiting for verifiable information. The volunteer nurse auxiliary in the La Source Chaude Clinic is refusing to give A29 or the community health committee information on cholera patients because we won't provide him with a salary or other means of compensation. As I mentioned before, the nurse auxiliary is a volunteer that does not have a good relationship with the community but is the only medical personnel that the community has. The Communal Director for MSPP (Dr. Carlo) is meeting with the community health committee, community leadership council, A29, and the nurse auxiliary on Friday to resolve the issue. A29's coordinator, Hebert Pierre, at this point can only verify the number of patients that he has seen at the clinic while he has been present in La Source for the last week. In general, the La Source Chaude clinic has had about 15-19 overnight cholera patients per day for the last five days at the CTC. We can confirm, too, that MSF ( I actually think she meant to say MSPP and had told me they also brought a tent)brought 9 boxes of supplies, (presumably hydration fluid) to the La Source Chaude clinic yesterday. After the meeting on Friday I will be able to give an inventory report on what was given. In terms of the Town of Anse Rouge, as I mentioned before, Hebert said that that clinic is closed. When he went to the clinic again on Tuesday to get information there was only a guardian there who could not provide him with any information. He is hoping to establish more formalised lines of communication today and tomorrow as he meets with CARE - who contacted him yesterday - and MSPP on Friday at the community meeting. ------------------------------------------- 11/22/10 Notes from Amber Hebert has not yet even met with the organization in PAP to know what supplies we will get . That appointment is at 10:00 today. The we still ahve to figure out transport for the supplies. As soon as we receive supplies I will let you know. These supplies will be for the La SOurce Chaude clinic FIRST and anything we can spare we will give to teh CIty Clinic. The City Clinic is on Route National One and patients can more easily find transport to Gonaives from that Center. That is not the case where we are in La SOurce Chaude. We need to have supplies at the La SOurce Chaude clinic because those people will not be able to make it to another location easily. It was a blessing that MSPP had a truck available to send to La Source last time. I dont think our luck wil be the same next time around. Water - the La Source Chaude clinic has water as we have hot springs in la Source Chaude (which means, in French, "hot spring"). The nurse auxillary who works there is highly incompetent and does not use the water filter that was set up for the clinic because he does not like the person who installed it. If he decided to use it again it has to be reinstalled and will be at least a few weeks before it is up and running. So we need aquatab or other water disinfectant for the clinic (as well as for the population in general). ---------------------------------------------- 11/21/10 Update on Assessment from Amber Munger When did cholera patients begin to come at this location? 9 or 10 November How many people does your facility serve? There are approximately 37,000 people in Commune Anse Rouge. Normally, the La SOurce Chaude clinic services about 1/6 of the population. Now that all other clinics except the one in the City of Anse Rouge have closed, people are coming from throughout the commune to the La Source Chaude clinic. Current Cholera Patient Load Up until November 18th there were only five cases (all of whom died). However, yesterday 63 patients walked or were transported to the La Source Chaude clinic many of them walking from extremely remote locations where they were expected to have brought cholera from Port-de-Paix. Most of the patients were coming from Tante, Yaya and Bonsinye, extremely high mountain regions that border third section Port-de-Paix. Fatality Rate for Cholera? Five of the five patients who had cholera until November 18th died; one is suspected of intentionally polluting the water source when he was shut out of the clinics, spreading cholera to three other people in the village of Kay Felip. Yesterday, November 20th one patient died and then 63 more people proceeded arrive at teh clinic. These people were transported in a MSPP truck to Gonaives. No one died en route but we are unclear as to what happened after they were deposited in Gonaives. Has number of patients stabilized? Today there were only seven patients in total. Yesterday was market day and people came from very far to the La Source market, explaining the huge increase in numbers. Medical Staffing (eg. no. of Doctors, no. of Nurses, no. of non medical staff): The community health clinic has no paid staff. There is only a volunteer nurse auxillary at the clinic. There are no qualified medical proffessionals (doctors or nurses) in the entire second section Commune Anse Rouge and only one that we know of in the first section. How many patients are you treating daily? Will update in a few days. How many hospitalized? Just transported all patients Does your facility provide Mobile Medical Clinics to the community?we do not have transportation available What is your Cholera Bed Capacity? There were only five beds in the La SOurce clinic. MSPP sent a tent for the clinic to set up in the lakou but have not provided beds. Describe accessibility to your site (e.g. Passable roads? Helicopter Landing Pad or spot? Airstrip for small planes? Please provide conditions for air landings and GPS coordinates). By road, it is a 2 hour trip from Gonaives (one hour on route national one and another hour on teh road from Letan to La Source Chaude). It is a very difficult road, even by Haiti standards. There is a helicopter landing strip in the City of Anse Rouge, which is a one hour drive from La Source Chaude, but is a much easier drive than the trip from Gonaives. Can you pick up supplies? We can pay local trucks to retrieve the supplies. THe local leaders in the community will offer the use of their large transport vehicles. Medical Supply needs (List by PRIORITY please). cholera related supplies and disinfectants. The clinic is also lacking in basic antibiotics for most other treatable illnesses. ---------------------------------------- 11/21/10 Email from Amber Hi folks - Just a quick update on this. Yesterday 63 patients showed up at the La Sources Chaude clinic after noon because all other clinics in Commune Anse Rouge (except for the one in the City of Anse Rouge) closed their doors to cholera patients. A29 Coordinator lobbied MSPP in Gonaives for help. In response, MSPP sent a truck to La Source Chaude to transport the 63 patients to Gonaives. Our coordinator said there were only a few patients who came to the La Source Clinic this morning before he left for PAP to try to seek medical supplies. MSPP sent us some fluid and IVs as well as a tent to set up a CTC in the lakou of the La Sous Clinic. The supplies will not last long. Hebert is in PAP meeting with Americare to see if they would be willing to give us free antibiotics, fluids, clorox for disinfecting the center, and aquatab. As I mentioned before, there are no qualified medical personnel in second section Commune Anse Rouge, and I am not sure that there are any either in the first section either (other than the regional director, who is helping to coordinate rather than see patients). ----------------------------------------- 11/21/10 Email from Amber I am on a call until 8:00 when I will get back to this but for now I wanted to make clear that A29 does not represent the ILODEP clinic. A29 is trying to find support for the community clinics - not the private clinic run by a private organization. I just received word that even the ILODEP clinic closed, just as all of the other private clinics. The private clinics will not accept cholera patients. Since I last wrote you yesterday, the La SOurce Chaude clinic received 63 patients - because all of the other clinics in the entire commune closed except for the City of Anse Rouge clinic which has no materials. Since the La SOurce Chaude clinic also had no materials, our coordinator Hebert Pierre worked with the Ministry of Health to try to find transport to Gonaives for all 63 of the patients. Gonaives is a treacherous two hour drive from La Source Chaude, and not many vehicles make the voyage. I will fill out the information on the sheet that you sent me just as soon as I am off the call with my board. Thanks for your help! ------------------------------------------- 11/21/10 Have requested Assesment information from Amber for clinic. lpar ------------------------------------------- Email from Amber Munger of Article 29 Organization 11/21/10 Commune Anse Rouge has approximately 37,000 residents but also services parts of Terre Neuve, raising the number to about 42,000. Article 29 Organization's base is in Second Section Commune Anse Rouge, which has four physical health clinics. One is the ILODEP clinic sponsored by Parole et Action, the other three are community clinics which have no paid staff and have not received supplies since July, the last time that A29 secured supplies for distribution to the clinics. There is no doctor or nurse in second section Commune Anse Rouge. There is rumored to be a doctor present in the City of Anse Rouge at the tent clinic (in first section Commune Anse Rouge) at the site of the old hospital that burnt down last year. This clinic is between a 2 to 8 hour walk for people in Second Section Commune Anse Rouge and there are virtually no taptaps or cars in the region. Cholera first entered Second Section Commune Anse Rouge about two weeks ago with cases coming in from people who had been in Gonaives. In second Section Commune Anse Rouge, we had five cases last week. The La Source Chaude clinic, which is the main clinic for the second section and is run by a volunteer nurse auxillary, closed its doors for fear of cholera. All five cholera victims died. A29's coordinator lobbied regional MSPP to re-open the clinic, which the volunteer nurse auxillary has now done, but there are currently no supplies (IV's, hydration fluids, antibiotics) to treat patients. Thus, more patients have arrived at the clinic, receive a cholera diagnosis, and then die. By the time the patients arrive at the clinic they have been too far along to respond to ORS, so IVs are needed. There are very few cars in the region so it is difficult to get patients to the City of Anse Rouge clinic, which as of yesterday was also out of IVs and rehydration fluids. As of yesterday, at least five more cholera patients found transport from SEcond Section Commune Anse Rouge to the City of Anse Rouge clinic in the first section. Two more died at the La Source Chaude clinic in Second Section. Five new patients had arrived at the La Source Clinic yesterday. A29 launched a public education and prevention campaign two weeks ago at teh regions two largest public markets (the City of Anse Rouge and the La Source Chaude markets). Information is spread by megaphone regarding prevention of cholera, treatment and how and when to make ORS. As a result of the outbreak in Gonaives, people are afraid to go to Gonaives for fear of contracting cholera. This puts the entire region in a precarious position as most of the region's supplies are procured in Gonaives (rice, oil, gas, everything). Commune Anse Rouge produces shallot and sourghum and pwa congo but no other crops in sufficient quantity to meet people's basic dietary needs - everything comes from Gonaives. There have been reports that one of the first two cholera victims in the region, when being shut out by the clinic and the community, deliberately polluted the drinking water source in Kay Felip, causing the other three people (of the initial five people) to contract cholera. There is a lot of panic and fear as a result, which could all easily be assuaged with the presence of a qualified doctor or nurse and some cholera medical supplies. A29 is currently engaged in efforts to secure supplies and transport for cholera treatment from PAP but has met with great challenges thus far. A29 is also attempting to engage medical teams to bring support to the region, which almost never receives such assistance because of its isolated location NW of Gonaives. -> 12/2/10: From conversation with Amber Market days are twice a week Thurs. and Sat. Missionary Air Sities uses airstrip. We were also able to hook them up with CARE for educational materials! Herbert has a meeting with them set up. ------------------------------------------------- 12/2/10 Email from Amber Munger ...still waiting for verifiable information. The volunteer nurse auxiliary in the La Source Chaude Clinic is refusing to give A29 or the community health committee information on cholera patients because we won't provide him with a salary or other means of compensation. As I mentioned before, the nurse auxiliary is a volunteer that does not have a good relationship with the community but is the only medical personnel that the community has. The Communal Director for MSPP (Dr. Carlo) is meeting with the community health committee, community leadership council, A29, and the nurse auxiliary on Friday to resolve the issue. A29's coordinator, Hebert Pierre, at this point can only verify the number of patients that he has seen at the clinic while he has been present in La Source for the last week. In general, the La Source Chaude clinic has had about 15-19 overnight cholera patients per day for the last five days at the CTC. We can confirm, too, that MSF brought 9 boxes of supplies, (presumably hydration fluid) (this is in addition to a large tent and small amt. of supplies that MSPP dropped off after 63 patients were transported)to the La Source Chaude clinic yesterday. After the meeting on Friday I will be able to give an inventory report on what was given. In terms of the Town of Anse Rouge, as I mentioned before, Hebert said that that clinic is closed. When he went to the clinic again on Tuesday to get information there was only a guardian there who could not provide him with any information. He is hoping to establish more formalised lines of communication today and tomorrow as he meets with CARE - who contacted him yesterday - and MSPP on Friday at the community meeting. ------------------------------------------- 11/22/10 Notes from Amber Hebert has not yet even met with the organization in PAP to know what supplies we will get . That appointment is at 10:00 today. The we still ahve to figure out transport for the supplies. As soon as we receive supplies I will let you know. These supplies will be for the La SOurce Chaude clinic FIRST and anything we can spare we will give to teh CIty Clinic. The City Clinic is on Route National One and patients can more easily find transport to Gonaives from that Center. That is not the case where we are in La SOurce Chaude. We need to have supplies at the La SOurce Chaude clinic because those people will not be able to make it to another location easily. It was a blessing that MSPP had a truck available to send to La Source last time. I dont think our luck wil be the same next time around. Water - the La Source Chaude clinic has water as we have hot springs in la Source Chaude (which means, in French, "hot spring"). The nurse auxillary who works there is highly incompetent and does not use the water filter that was set up for the clinic because he does not like the person who installed it. If he decided to use it again it has to be reinstalled and will be at least a few weeks before it is up and running. So we need aquatab or other water disinfectant for the clinic (as well as for the population in general). ---------------------------------------------- 11/21/10 Update on Assessment from Amber Munger When did cholera patients begin to come at this location? 9 or 10 November How many people does your facility serve? There are approximately 37,000 people in Commune Anse Rouge. Normally, the La SOurce Chaude clinic services about 1/6 of the population. Now that all other clinics except the one in the City of Anse Rouge have closed, people are coming from throughout the commune to the La Source Chaude clinic. Current Cholera Patient Load Up until November 18th there were only five cases (all of whom died). However, yesterday 63 patients walked or were transported to the La Source Chaude clinic many of them walking from extremely remote locations where they were expected to have brought cholera from Port-de-Paix. Most of the patients were coming from Tante, Yaya and Bonsinye, extremely high mountain regions that border third section Port-de-Paix. Fatality Rate for Cholera? Five of the five patients who had cholera until November 18th died; one is suspected of intentionally polluting the water source when he was shut out of the clinics, spreading cholera to three other people in the village of Kay Felip. Yesterday, November 20th one patient died and then 63 more people proceeded arrive at teh clinic. These people were transported in a MSPP truck to Gonaives. No one died en route but we are unclear as to what happened after they were deposited in Gonaives. Has number of patients stabilized? Today there were only seven patients in total. Yesterday was market day and people came from very far to the La Source market, explaining the huge increase in numbers. Medical Staffing (eg. no. of Doctors, no. of Nurses, no. of non medical staff): The community health clinic has no paid staff. There is only a volunteer nurse auxillary at the clinic. There are no qualified medical proffessionals (doctors or nurses) in the entire second section Commune Anse Rouge and only one that we know of in the first section. How many patients are you treating daily? Will update in a few days. How many hospitalized? Just transported all patients Does your facility provide Mobile Medical Clinics to the community?we do not have transportation available What is your Cholera Bed Capacity? There were only five beds in the La SOurce clinic. MSPP sent a tent for the clinic to set up in the lakou but have not provided beds. Describe accessibility to your site (e.g. Passable roads? Helicopter Landing Pad or spot? Airstrip for small planes? Please provide conditions for air landings and GPS coordinates). By road, it is a 2 hour trip from Gonaives (one hour on route national one and another hour on teh road from Letan to La Source Chaude). It is a very difficult road, even by Haiti standards. There is a helicopter landing strip in the City of Anse Rouge, which is a one hour drive from La Source Chaude, but is a much easier drive than the trip from Gonaives. Can you pick up supplies? We can pay local trucks to retrieve the supplies. THe local leaders in the community will offer the use of their large transport vehicles. Medical Supply needs (List by PRIORITY please). cholera related supplies and disinfectants. The clinic is also lacking in basic antibiotics for most other treatable illnesses. ---------------------------------------- 11/21/10 Email from Amber Hi folks - Just a quick update on this. Yesterday 63 patients showed up at the La Sources Chaude clinic after noon because all other clinics in Commune Anse Rouge (except for the one in the City of Anse Rouge) closed their doors to cholera patients. A29 Coordinator lobbied MSPP in Gonaives for help. In response, MSPP sent a truck to La Source Chaude to transport the 63 patients to Gonaives. Our coordinator said there were only a few patients who came to the La Source Clinic this morning before he left for PAP to try to seek medical supplies. MSPP sent us some fluid and IVs as well as a tent to set up a CTC in the lakou of the La Sous Clinic. The supplies will not last long. Hebert is in PAP meeting with Americare to see if they would be willing to give us free antibiotics, fluids, clorox for disinfecting the center, and aquatab. As I mentioned before, there are no qualified medical personnel in second section Commune Anse Rouge, and I am not sure that there are any either in the first section either (other than the regional director, who is helping to coordinate rather than see patients). ----------------------------------------- 11/21/10 Email from Amber I am on a call until 8:00 when I will get back to this but for now I wanted to make clear that A29 does not represent the ILODEP clinic. A29 is trying to find support for the community clinics - not the private clinic run by a private organization. I just received word that even the ILODEP clinic closed, just as all of the other private clinics. The private clinics will not accept cholera patients. Since I last wrote you yesterday, the La SOurce Chaude clinic received 63 patients - because all of the other clinics in the entire commune closed except for the City of Anse Rouge clinic which has no materials. Since the La SOurce Chaude clinic also had no materials, our coordinator Hebert Pierre worked with the Ministry of Health to try to find transport to Gonaives for all 63 of the patients. Gonaives is a treacherous two hour drive from La Source Chaude, and not many vehicles make the voyage. I will fill out the information on the sheet that you sent me just as soon as I am off the call with my board. Thanks for your help! ------------------------------------------- 11/21/10 Have requested Assesment information from Amber for clinic. lpar ------------------------------------------- Email from Amber Munger of Article 29 Organization 11/21/10 Commune Anse Rouge has approximately 37,000 residents but also services parts of Terre Neuve, raising the number to about 42,000. Article 29 Organization's base is in Second Section Commune Anse Rouge, which has four physical health clinics. One is the ILODEP clinic sponsored by Parole et Action, the other three are community clinics which have no paid staff and have not received supplies since July, the last time that A29 secured supplies for distribution to the clinics. There is no doctor or nurse in second section Commune Anse Rouge. There is rumored to be a doctor present in the City of Anse Rouge at the tent clinic (in first section Commune Anse Rouge) at the site of the old hospital that burnt down last year. This clinic is between a 2 to 8 hour walk for people in Second Section Commune Anse Rouge and there are virtually no taptaps or cars in the region. Cholera first entered Second Section Commune Anse Rouge about two weeks ago with cases coming in from people who had been in Gonaives. In second Section Commune Anse Rouge, we had five cases last week. The La Source Chaude clinic, which is the main clinic for the second section and is run by a volunteer nurse auxillary, closed its doors for fear of cholera. All five cholera victims died. A29's coordinator lobbied regional MSPP to re-open the clinic, which the volunteer nurse auxillary has now done, but there are currently no supplies (IV's, hydration fluids, antibiotics) to treat patients. Thus, more patients have arrived at the clinic, receive a cholera diagnosis, and then die. By the time the patients arrive at the clinic they have been too far along to respond to ORS, so IVs are needed. There are very few cars in the region so it is difficult to get patients to the City of Anse Rouge clinic, which as of yesterday was also out of IVs and rehydration fluids. As of yesterday, at least five more cholera patients found transport from SEcond Section Commune Anse Rouge to the City of Anse Rouge clinic in the first section. Two more died at the La Source Chaude clinic in Second Section. Five new patients had arrived at the La Source Clinic yesterday. A29 launched a public education and prevention campaign two weeks ago at teh regions two largest public markets (the City of Anse Rouge and the La Source Chaude markets). Information is spread by megaphone regarding prevention of cholera, treatment and how and when to make ORS. As a result of the outbreak in Gonaives, people are afraid to go to Gonaives for fear of contracting cholera. This puts the entire region in a precarious position as most of the region's supplies are procured in Gonaives (rice, oil, gas, everything). Commune Anse Rouge produces shallot and sourghum and pwa congo but no other crops in sufficient quantity to meet people's basic dietary needs - everything comes from Gonaives. There have been reports that one of the first two cholera victims in the region, when being shut out by the clinic and the community, deliberately polluted the drinking water source in Kay Felip, causing the other three people (of the initial five people) to contract cholera. There is a lot of panic and fear as a result, which could all easily be assuaged with the presence of a qualified doctor or nurse and some cholera medical supplies. A29 is currently engaged in efforts to secure supplies and transport for cholera treatment from PAP but has met with great challenges thus far. A29 is also attempting to engage medical teams to bring support to the region, which almost never receives such assistance because of its isolated location NW of Gonaives.

notes: 12/2/10: From conversation with Amber Market days are twice a week Thurs. and Sat. Missionary Air Sities uses airstrip. ------------------------------------------------- 12/2/10 Email from Amber Munger ...still waiting for verifiable information. The volunteer nurse auxiliary in the La Source Chaude Clinic is refusing to give A29 or the community health committee information on cholera patients because we won't provide him with a salary or other means of compensation. As I mentioned before, the nurse auxiliary is a volunteer that does not have a good relationship with the community but is the only medical personnel that the community has. The Communal Director for MSPP (Dr. Carlo) is meeting with the community health committee, community leadership council, A29, and the nurse auxiliary on Friday to resolve the issue. A29's coordinator, Hebert Pierre, at this point can only verify the number of patients that he has seen at the clinic while he has been present in La Source for the last week. In general, the La Source Chaude clinic has had about 15-19 overnight cholera patients per day for the last five days at the CTC. We can confirm, too, that MSF ( I actually think she meant to say MSPP and had told me they also brought a tent)brought 9 boxes of supplies, (presumably hydration fluid) to the La Source Chaude clinic yesterday. After the meeting on Friday I will be able to give an inventory report on what was given. In terms of the Town of Anse Rouge, as I mentioned before, Hebert said that that clinic is closed. When he went to the clinic again on Tuesday to get information there was only a guardian there who could not provide him with any information. He is hoping to establish more formalised lines of communication today and tomorrow as he meets with CARE - who contacted him yesterday - and MSPP on Friday at the community meeting. ------------------------------------------- 11/22/10 Notes from Amber Hebert has not yet even met with the organization in PAP to know what supplies we will get . That appointment is at 10:00 today. The we still ahve to figure out transport for the supplies. As soon as we receive supplies I will let you know. These supplies will be for the La SOurce Chaude clinic FIRST and anything we can spare we will give to teh CIty Clinic. The City Clinic is on Route National One and patients can more easily find transport to Gonaives from that Center. That is not the case where we are in La SOurce Chaude. We need to have supplies at the La SOurce Chaude clinic because those people will not be able to make it to another location easily. It was a blessing that MSPP had a truck available to send to La Source last time. I dont think our luck wil be the same next time around. Water - the La Source Chaude clinic has water as we have hot springs in la Source Chaude (which means, in French, "hot spring"). The nurse auxillary who works there is highly incompetent and does not use the water filter that was set up for the clinic because he does not like the person who installed it. If he decided to use it again it has to be reinstalled and will be at least a few weeks before it is up and running. So we need aquatab or other water disinfectant for the clinic (as well as for the population in general). ---------------------------------------------- 11/21/10 Update on Assessment from Amber Munger When did cholera patients begin to come at this location? 9 or 10 November How many people does your facility serve? There are approximately 37,000 people in Commune Anse Rouge. Normally, the La SOurce Chaude clinic services about 1/6 of the population. Now that all other clinics except the one in the City of Anse Rouge have closed, people are coming from throughout the commune to the La Source Chaude clinic. Current Cholera Patient Load Up until November 18th there were only five cases (all of whom died). However, yesterday 63 patients walked or were transported to the La Source Chaude clinic many of them walking from extremely remote locations where they were expected to have brought cholera from Port-de-Paix. Most of the patients were coming from Tante, Yaya and Bonsinye, extremely high mountain regions that border third section Port-de-Paix. Fatality Rate for Cholera? Five of the five patients who had cholera until November 18th died; one is suspected of intentionally polluting the water source when he was shut out of the clinics, spreading cholera to three other people in the village of Kay Felip. Yesterday, November 20th one patient died and then 63 more people proceeded arrive at teh clinic. These people were transported in a MSPP truck to Gonaives. No one died en route but we are unclear as to what happened after they were deposited in Gonaives. Has number of patients stabilized? Today there were only seven patients in total. Yesterday was market day and people came from very far to the La Source market, explaining the huge increase in numbers. Medical Staffing (eg. no. of Doctors, no. of Nurses, no. of non medical staff): The community health clinic has no paid staff. There is only a volunteer nurse auxillary at the clinic. There are no qualified medical proffessionals (doctors or nurses) in the entire second section Commune Anse Rouge and only one that we know of in the first section. How many patients are you treating daily? Will update in a few days. How many hospitalized? Just transported all patients Does your facility provide Mobile Medical Clinics to the community?we do not have transportation available What is your Cholera Bed Capacity? There were only five beds in the La SOurce clinic. MSPP sent a tent for the clinic to set up in the lakou but have not provided beds. Describe accessibility to your site (e.g. Passable roads? Helicopter Landing Pad or spot? Airstrip for small planes? Please provide conditions for air landings and GPS coordinates). By road, it is a 2 hour trip from Gonaives (one hour on route national one and another hour on teh road from Letan to La Source Chaude). It is a very difficult road, even by Haiti standards. There is a helicopter landing strip in the City of Anse Rouge, which is a one hour drive from La Source Chaude, but is a much easier drive than the trip from Gonaives. Can you pick up supplies? We can pay local trucks to retrieve the supplies. THe local leaders in the community will offer the use of their large transport vehicles. Medical Supply needs (List by PRIORITY please). cholera related supplies and disinfectants. The clinic is also lacking in basic antibiotics for most other treatable illnesses. ---------------------------------------- 11/21/10 Email from Amber Hi folks - Just a quick update on this. Yesterday 63 patients showed up at the La Sources Chaude clinic after noon because all other clinics in Commune Anse Rouge (except for the one in the City of Anse Rouge) closed their doors to cholera patients. A29 Coordinator lobbied MSPP in Gonaives for help. In response, MSPP sent a truck to La Source Chaude to transport the 63 patients to Gonaives. Our coordinator said there were only a few patients who came to the La Source Clinic this morning before he left for PAP to try to seek medical supplies. MSPP sent us some fluid and IVs as well as a tent to set up a CTC in the lakou of the La Sous Clinic. The supplies will not last long. Hebert is in PAP meeting with Americare to see if they would be willing to give us free antibiotics, fluids, clorox for disinfecting the center, and aquatab. As I mentioned before, there are no qualified medical personnel in second section Commune Anse Rouge, and I am not sure that there are any either in the first section either (other than the regional director, who is helping to coordinate rather than see patients). ----------------------------------------- 11/21/10 Email from Amber I am on a call until 8:00 when I will get back to this but for now I wanted to make clear that A29 does not represent the ILODEP clinic. A29 is trying to find support for the community clinics - not the private clinic run by a private organization. I just received word that even the ILODEP clinic closed, just as all of the other private clinics. The private clinics will not accept cholera patients. Since I last wrote you yesterday, the La SOurce Chaude clinic received 63 patients - because all of the other clinics in the entire commune closed except for the City of Anse Rouge clinic which has no materials. Since the La SOurce Chaude clinic also had no materials, our coordinator Hebert Pierre worked with the Ministry of Health to try to find transport to Gonaives for all 63 of the patients. Gonaives is a treacherous two hour drive from La Source Chaude, and not many vehicles make the voyage. I will fill out the information on the sheet that you sent me just as soon as I am off the call with my board. Thanks for your help! ------------------------------------------- 11/21/10 Have requested Assesment information from Amber for clinic. lpar ------------------------------------------- Email from Amber Munger of Article 29 Organization 11/21/10 Commune Anse Rouge has approximately 37,000 residents but also services parts of Terre Neuve, raising the number to about 42,000. Article 29 Organization's base is in Second Section Commune Anse Rouge, which has four physical health clinics. One is the ILODEP clinic sponsored by Parole et Action, the other three are community clinics which have no paid staff and have not received supplies since July, the last time that A29 secured supplies for distribution to the clinics. There is no doctor or nurse in second section Commune Anse Rouge. There is rumored to be a doctor present in the City of Anse Rouge at the tent clinic (in first section Commune Anse Rouge) at the site of the old hospital that burnt down last year. This clinic is between a 2 to 8 hour walk for people in Second Section Commune Anse Rouge and there are virtually no taptaps or cars in the region. Cholera first entered Second Section Commune Anse Rouge about two weeks ago with cases coming in from people who had been in Gonaives. In second Section Commune Anse Rouge, we had five cases last week. The La Source Chaude clinic, which is the main clinic for the second section and is run by a volunteer nurse auxillary, closed its doors for fear of cholera. All five cholera victims died. A29's coordinator lobbied regional MSPP to re-open the clinic, which the volunteer nurse auxillary has now done, but there are currently no supplies (IV's, hydration fluids, antibiotics) to treat patients. Thus, more patients have arrived at the clinic, receive a cholera diagnosis, and then die. By the time the patients arrive at the clinic they have been too far along to respond to ORS, so IVs are needed. There are very few cars in the region so it is difficult to get patients to the City of Anse Rouge clinic, which as of yesterday was also out of IVs and rehydration fluids. As of yesterday, at least five more cholera patients found transport from SEcond Section Commune Anse Rouge to the City of Anse Rouge clinic in the first section. Two more died at the La Source Chaude clinic in Second Section. Five new patients had arrived at the La Source Clinic yesterday. A29 launched a public education and prevention campaign two weeks ago at teh regions two largest public markets (the City of Anse Rouge and the La Source Chaude markets). Information is spread by megaphone regarding prevention of cholera, treatment and how and when to make ORS. As a result of the outbreak in Gonaives, people are afraid to go to Gonaives for fear of contracting cholera. This puts the entire region in a precarious position as most of the region's supplies are procured in Gonaives (rice, oil, gas, everything). Commune Anse Rouge produces shallot and sourghum and pwa congo but no other crops in sufficient quantity to meet people's basic dietary needs - everything comes from Gonaives. There have been reports that one of the first two cholera victims in the region, when being shut out by the clinic and the community, deliberately polluted the drinking water source in Kay Felip, causing the other three people (of the initial five people) to contract cholera. There is a lot of panic and fear as a result, which could all easily be assuaged with the presence of a qualified doctor or nurse and some cholera medical supplies. A29 is currently engaged in efforts to secure supplies and transport for cholera treatment from PAP but has met with great challenges thus far. A29 is also attempting to engage medical teams to bring support to the region, which almost never receives such assistance because of its isolated location NW of Gonaives. -> 12/2/10: From conversation with Amber Market days are twice a week Thurs. and Sat. Missionary Air Sities uses airstrip. We were also able to hook them up with CARE for educational materials! Herbert has a meeting with them set up. ------------------------------------------------- 12/2/10 Email from Amber Munger ...still waiting for verifiable information. The volunteer nurse auxiliary in the La Source Chaude Clinic is refusing to give A29 or the community health committee information on cholera patients because we won't provide him with a salary or other means of compensation. As I mentioned before, the nurse auxiliary is a volunteer that does not have a good relationship with the community but is the only medical personnel that the community has. The Communal Director for MSPP (Dr. Carlo) is meeting with the community health committee, community leadership council, A29, and the nurse auxiliary on Friday to resolve the issue. A29's coordinator, Hebert Pierre, at this point can only verify the number of patients that he has seen at the clinic while he has been present in La Source for the last week. In general, the La Source Chaude clinic has had about 15-19 overnight cholera patients per day for the last five days at the CTC. We can confirm, too, that MSF ( I actually think she meant to say MSPP and had told me they also brought a tent)brought 9 boxes of supplies, (presumably hydration fluid) to the La Source Chaude clinic yesterday. After the meeting on Friday I will be able to give an inventory report on what was given. In terms of the Town of Anse Rouge, as I mentioned before, Hebert said that that clinic is closed. When he went to the clinic again on Tuesday to get information there was only a guardian there who could not provide him with any information. He is hoping to establish more formalised lines of communication today and tomorrow as he meets with CARE - who contacted him yesterday - and MSPP on Friday at the community meeting. ------------------------------------------- 11/22/10 Notes from Amber Hebert has not yet even met with the organization in PAP to know what supplies we will get . That appointment is at 10:00 today. The we still ahve to figure out transport for the supplies. As soon as we receive supplies I will let you know. These supplies will be for the La SOurce Chaude clinic FIRST and anything we can spare we will give to teh CIty Clinic. The City Clinic is on Route National One and patients can more easily find transport to Gonaives from that Center. That is not the case where we are in La SOurce Chaude. We need to have supplies at the La SOurce Chaude clinic because those people will not be able to make it to another location easily. It was a blessing that MSPP had a truck available to send to La Source last time. I dont think our luck wil be the same next time around. Water - the La Source Chaude clinic has water as we have hot springs in la Source Chaude (which means, in French, "hot spring"). The nurse auxillary who works there is highly incompetent and does not use the water filter that was set up for the clinic because he does not like the person who installed it. If he decided to use it again it has to be reinstalled and will be at least a few weeks before it is up and running. So we need aquatab or other water disinfectant for the clinic (as well as for the population in general). ---------------------------------------------- 11/21/10 Update on Assessment from Amber Munger When did cholera patients begin to come at this location? 9 or 10 November How many people does your facility serve? There are approximately 37,000 people in Commune Anse Rouge. Normally, the La SOurce Chaude clinic services about 1/6 of the population. Now that all other clinics except the one in the City of Anse Rouge have closed, people are coming from throughout the commune to the La Source Chaude clinic. Current Cholera Patient Load Up until November 18th there were only five cases (all of whom died). However, yesterday 63 patients walked or were transported to the La Source Chaude clinic many of them walking from extremely remote locations where they were expected to have brought cholera from Port-de-Paix. Most of the patients were coming from Tante, Yaya and Bonsinye, extremely high mountain regions that border third section Port-de-Paix. Fatality Rate for Cholera? Five of the five patients who had cholera until November 18th died; one is suspected of intentionally polluting the water source when he was shut out of the clinics, spreading cholera to three other people in the village of Kay Felip. Yesterday, November 20th one patient died and then 63 more people proceeded arrive at teh clinic. These people were transported in a MSPP truck to Gonaives. No one died en route but we are unclear as to what happened after they were deposited in Gonaives. Has number of patients stabilized? Today there were only seven patients in total. Yesterday was market day and people came from very far to the La Source market, explaining the huge increase in numbers. Medical Staffing (eg. no. of Doctors, no. of Nurses, no. of non medical staff): The community health clinic has no paid staff. There is only a volunteer nurse auxillary at the clinic. There are no qualified medical proffessionals (doctors or nurses) in the entire second section Commune Anse Rouge and only one that we know of in the first section. How many patients are you treating daily? Will update in a few days. How many hospitalized? Just transported all patients Does your facility provide Mobile Medical Clinics to the community?we do not have transportation available What is your Cholera Bed Capacity? There were only five beds in the La SOurce clinic. MSPP sent a tent for the clinic to set up in the lakou but have not provided beds. Describe accessibility to your site (e.g. Passable roads? Helicopter Landing Pad or spot? Airstrip for small planes? Please provide conditions for air landings and GPS coordinates). By road, it is a 2 hour trip from Gonaives (one hour on route national one and another hour on teh road from Letan to La Source Chaude). It is a very difficult road, even by Haiti standards. There is a helicopter landing strip in the City of Anse Rouge, which is a one hour drive from La Source Chaude, but is a much easier drive than the trip from Gonaives. Can you pick up supplies? We can pay local trucks to retrieve the supplies. THe local leaders in the community will offer the use of their large transport vehicles. Medical Supply needs (List by PRIORITY please). cholera related supplies and disinfectants. The clinic is also lacking in basic antibiotics for most other treatable illnesses. ---------------------------------------- 11/21/10 Email from Amber Hi folks - Just a quick update on this. Yesterday 63 patients showed up at the La Sources Chaude clinic after noon because all other clinics in Commune Anse Rouge (except for the one in the City of Anse Rouge) closed their doors to cholera patients. A29 Coordinator lobbied MSPP in Gonaives for help. In response, MSPP sent a truck to La Source Chaude to transport the 63 patients to Gonaives. Our coordinator said there were only a few patients who came to the La Source Clinic this morning before he left for PAP to try to seek medical supplies. MSPP sent us some fluid and IVs as well as a tent to set up a CTC in the lakou of the La Sous Clinic. The supplies will not last long. Hebert is in PAP meeting with Americare to see if they would be willing to give us free antibiotics, fluids, clorox for disinfecting the center, and aquatab. As I mentioned before, there are no qualified medical personnel in second section Commune Anse Rouge, and I am not sure that there are any either in the first section either (other than the regional director, who is helping to coordinate rather than see patients). ----------------------------------------- 11/21/10 Email from Amber I am on a call until 8:00 when I will get back to this but for now I wanted to make clear that A29 does not represent the ILODEP clinic. A29 is trying to find support for the community clinics - not the private clinic run by a private organization. I just received word that even the ILODEP clinic closed, just as all of the other private clinics. The private clinics will not accept cholera patients. Since I last wrote you yesterday, the La SOurce Chaude clinic received 63 patients - because all of the other clinics in the entire commune closed except for the City of Anse Rouge clinic which has no materials. Since the La SOurce Chaude clinic also had no materials, our coordinator Hebert Pierre worked with the Ministry of Health to try to find transport to Gonaives for all 63 of the patients. Gonaives is a treacherous two hour drive from La Source Chaude, and not many vehicles make the voyage. I will fill out the information on the sheet that you sent me just as soon as I am off the call with my board. Thanks for your help! ------------------------------------------- 11/21/10 Have requested Assesment information from Amber for clinic. lpar ------------------------------------------- Email from Amber Munger of Article 29 Organization 11/21/10 Commune Anse Rouge has approximately 37,000 residents but also services parts of Terre Neuve, raising the number to about 42,000. Article 29 Organization's base is in Second Section Commune Anse Rouge, which has four physical health clinics. One is the ILODEP clinic sponsored by Parole et Action, the other three are community clinics which have no paid staff and have not received supplies since July, the last time that A29 secured supplies for distribution to the clinics. There is no doctor or nurse in second section Commune Anse Rouge. There is rumored to be a doctor present in the City of Anse Rouge at the tent clinic (in first section Commune Anse Rouge) at the site of the old hospital that burnt down last year. This clinic is between a 2 to 8 hour walk for people in Second Section Commune Anse Rouge and there are virtually no taptaps or cars in the region. Cholera first entered Second Section Commune Anse Rouge about two weeks ago with cases coming in from people who had been in Gonaives. In second Section Commune Anse Rouge, we had five cases last week. The La Source Chaude clinic, which is the main clinic for the second section and is run by a volunteer nurse auxillary, closed its doors for fear of cholera. All five cholera victims died. A29's coordinator lobbied regional MSPP to re-open the clinic, which the volunteer nurse auxillary has now done, but there are currently no supplies (IV's, hydration fluids, antibiotics) to treat patients. Thus, more patients have arrived at the clinic, receive a cholera diagnosis, and then die. By the time the patients arrive at the clinic they have been too far along to respond to ORS, so IVs are needed. There are very few cars in the region so it is difficult to get patients to the City of Anse Rouge clinic, which as of yesterday was also out of IVs and rehydration fluids. As of yesterday, at least five more cholera patients found transport from SEcond Section Commune Anse Rouge to the City of Anse Rouge clinic in the first section. Two more died at the La Source Chaude clinic in Second Section. Five new patients had arrived at the La Source Clinic yesterday. A29 launched a public education and prevention campaign two weeks ago at teh regions two largest public markets (the City of Anse Rouge and the La Source Chaude markets). Information is spread by megaphone regarding prevention of cholera, treatment and how and when to make ORS. As a result of the outbreak in Gonaives, people are afraid to go to Gonaives for fear of contracting cholera. This puts the entire region in a precarious position as most of the region's supplies are procured in Gonaives (rice, oil, gas, everything). Commune Anse Rouge produces shallot and sourghum and pwa congo but no other crops in sufficient quantity to meet people's basic dietary needs - everything comes from Gonaives. There have been reports that one of the first two cholera victims in the region, when being shut out by the clinic and the community, deliberately polluted the drinking water source in Kay Felip, causing the other three people (of the initial five people) to contract cholera. There is a lot of panic and fear as a result, which could all easily be assuaged with the presence of a qualified doctor or nurse and some cholera medical supplies. A29 is currently engaged in efforts to secure supplies and transport for cholera treatment from PAP but has met with great challenges thus far. A29 is also attempting to engage medical teams to bring support to the region, which almost never receives such assistance because of its isolated location NW of Gonaives.

address: Second Section Commune Helicopter Coord. next to clinic 19 degrees 37'51.49" N 72 degrees 55'07.19" W -> Second Section Commune Clinic Coord: 19 degrees 38'10.66" N 72 degrees 54'58.93" W Helicopter Coord. next to clinic (approx.) 19 degrees 37'51.49" N 72 degrees 55'07.19" W 2 hours from Gonavies, road partially really bad
notes: 11/22/10 Notes from Amber Hebert has not yet even met with the organization in PAP to know what supplies we will get . That appointment is at 10:00 today. The we still ahve to figure out transport for the supplies. As soon as we receive supplies I will let you know. These supplies will be for the La SOurce Chaude clinic FIRST and anything we can spare we will give to teh CIty Clinic. The City Clinic is on Route National One and patients can more easily find transport to Gonaives from that Center. That is not the case where we are in La SOurce Chaude. We need to have supplies at the La SOurce Chaude clinic because those people will not be able to make it to another location easily. It was a blessing that MSPP had a truck available to send to La Source last time. I dont think our luck wil be the same next time around. Water - the La Source Chaude clinic has water as we have hot springs in la Source Chaude (which means, in French, "hot spring"). The nurse auxillary who works there is highly incompetent and does not use the water filter that was set up for the clinic because he does not like the person who installed it. If he decided to use it again it has to be reinstalled and will be at least a few weeks before it is up and running. So we need aquatab or other water disinfectant for the clinic (as well as for the population in general). 11/21/10 Update on Assessment from Amber Munger When did cholera patients begin to come at this location? 9 or 10 November How many people does your facility serve? There are approximately 37,000 people in Commune Anse Rouge. Normally, the La SOurce Chaude clinic services about 1/6 of the population. Now that all other clinics except the one in the City of Anse Rouge have closed, people are coming from throughout the commune to the La Source Chaude clinic. Current Cholera Patient Load Up until November 18th there were only five cases (all of whom died). However, yesterday 63 patients walked or were transported to the La Source Chaude clinic many of them walking from extremely remote locations where they were expected to have brought cholera from Port-de-Paix. Most of the patients were coming from Tante, Yaya and Bonsinye, extremely high mountain regions that border third section Port-de-Paix. Fatality Rate for Cholera? Five of the five patients who had cholera until November 18th died; one is suspected of intentionally polluting the water source when he was shut out of the clinics, spreading cholera to three other people in the village of Kay Felip. Yesterday, November 20th one patient died and then 63 more people proceeded arrive at teh clinic. These people were transported in a MSPP truck to Gonaives. No one died en route but we are unclear as to what happened after they were deposited in Gonaives. Has number of patients stabilized? Today there were only seven patients in total. Yesterday was market day and people came from very far to the La Source market, explaining the huge increase in numbers. Medical Staffing (eg. no. of Doctors, no. of Nurses, no. of non medical staff): The community health clinic has no paid staff. There is only a volunteer nurse auxillary at the clinic. There are no qualified medical proffessionals (doctors or nurses) in the entire second section Commune Anse Rouge and only one that we know of in the first section. How many patients are you treating daily? Will update in a few days. How many hospitalized? Just transported all patients Does your facility provide Mobile Medical Clinics to the community?we do not have transportation available What is your Cholera Bed Capacity? There were only five beds in the La SOurce clinic. MSPP sent a tent for the clinic to set up in the lakou but have not provided beds. Describe accessibility to your site (e.g. Passable roads? Helicopter Landing Pad or spot? Airstrip for small planes? Please provide conditions for air landings and GPS coordinates). By road, it is a 2 hour trip from Gonaives (one hour on route national one and another hour on teh road from Letan to La Source Chaude). It is a very difficult road, even by Haiti standards. There is a helicopter landing strip in the City of Anse Rouge, which is a one hour drive from La Source Chaude, but is a much easier drive than the trip from Gonaives. Can you pick up supplies? We can pay local trucks to retrieve the supplies. THe local leaders in the community will offer the use of their large transport vehicles. Medical Supply needs (List by PRIORITY please). cholera related supplies and disinfectants. The clinic is also lacking in basic antibiotics for most other treatable illnesses. ---------------------------------------- 11/21/10 Email from Amber Hi folks - Just a quick update on this. Yesterday 63 patients showed up at the La Sources Chaude clinic after noon because all other clinics in Commune Anse Rouge (except for the one in the City of Anse Rouge) closed their doors to cholera patients. A29 Coordinator lobbied MSPP in Gonaives for help. In response, MSPP sent a truck to La Source Chaude to transport the 63 patients to Gonaives. Our coordinator said there were only a few patients who came to the La Source Clinic this morning before he left for PAP to try to seek medical supplies. MSPP sent us some fluid and IVs as well as a tent to set up a CTC in the lakou of the La Sous Clinic. The supplies will not last long. Hebert is in PAP meeting with Americare to see if they would be willing to give us free antibiotics, fluids, clorox for disinfecting the center, and aquatab. As I mentioned before, there are no qualified medical personnel in second section Commune Anse Rouge, and I am not sure that there are any either in the first section either (other than the regional director, who is helping to coordinate rather than see patients). ----------------------------------------- 11/21/10 Email from Amber I am on a call until 8:00 when I will get back to this but for now I wanted to make clear that A29 does not represent the ILODEP clinic. A29 is trying to find support for the community clinics - not the private clinic run by a private organization. I just received word that even the ILODEP clinic closed, just as all of the other private clinics. The private clinics will not accept cholera patients. Since I last wrote you yesterday, the La SOurce Chaude clinic received 63 patients - because all of the other clinics in the entire commune closed except for the City of Anse Rouge clinic which has no materials. Since the La SOurce Chaude clinic also had no materials, our coordinator Hebert Pierre worked with the Ministry of Health to try to find transport to Gonaives for all 63 of the patients. Gonaives is a treacherous two hour drive from La Source Chaude, and not many vehicles make the voyage. I will fill out the information on the sheet that you sent me just as soon as I am off the call with my board. Thanks for your help! ------------------------------------------- 11/21/10 Have requested Assesment information from Amber for clinic. lpar ------------------------------------------- Email from Amber Munger of Article 29 Organization 11/21/10 Commune Anse Rouge has approximately 37,000 residents but also services parts of Terre Neuve, raising the number to about 42,000. Article 29 Organization's base is in Second Section Commune Anse Rouge, which has four physical health clinics. One is the ILODEP clinic sponsored by Parole et Action, the other three are community clinics which have no paid staff and have not received supplies since July, the last time that A29 secured supplies for distribution to the clinics. There is no doctor or nurse in second section Commune Anse Rouge. There is rumored to be a doctor present in the City of Anse Rouge at the tent clinic (in first section Commune Anse Rouge) at the site of the old hospital that burnt down last year. This clinic is between a 2 to 8 hour walk for people in Second Section Commune Anse Rouge and there are virtually no taptaps or cars in the region. Cholera first entered Second Section Commune Anse Rouge about two weeks ago with cases coming in from people who had been in Gonaives. In second Section Commune Anse Rouge, we had five cases last week. The La Source Chaude clinic, which is the main clinic for the second section and is run by a volunteer nurse auxillary, closed its doors for fear of cholera. All five cholera victims died. A29's coordinator lobbied regional MSPP to re-open the clinic, which the volunteer nurse auxillary has now done, but there are currently no supplies (IV's, hydration fluids, antibiotics) to treat patients. Thus, more patients have arrived at the clinic, receive a cholera diagnosis, and then die. By the time the patients arrive at the clinic they have been too far along to respond to ORS, so IVs are needed. There are very few cars in the region so it is difficult to get patients to the City of Anse Rouge clinic, which as of yesterday was also out of IVs and rehydration fluids. As of yesterday, at least five more cholera patients found transport from SEcond Section Commune Anse Rouge to the City of Anse Rouge clinic in the first section. Two more died at the La Source Chaude clinic in Second Section. Five new patients had arrived at the La Source Clinic yesterday. A29 launched a public education and prevention campaign two weeks ago at teh regions two largest public markets (the City of Anse Rouge and the La Source Chaude markets). Information is spread by megaphone regarding prevention of cholera, treatment and how and when to make ORS. As a result of the outbreak in Gonaives, people are afraid to go to Gonaives for fear of contracting cholera. This puts the entire region in a precarious position as most of the region's supplies are procured in Gonaives (rice, oil, gas, everything). Commune Anse Rouge produces shallot and sourghum and pwa congo but no other crops in sufficient quantity to meet people's basic dietary needs - everything comes from Gonaives. There have been reports that one of the first two cholera victims in the region, when being shut out by the clinic and the community, deliberately polluted the drinking water source in Kay Felip, causing the other three people (of the initial five people) to contract cholera. There is a lot of panic and fear as a result, which could all easily be assuaged with the presence of a qualified doctor or nurse and some cholera medical supplies. A29 is currently engaged in efforts to secure supplies and transport for cholera treatment from PAP but has met with great challenges thus far. A29 is also attempting to engage medical teams to bring support to the region, which almost never receives such assistance because of its isolated location NW of Gonaives. -> 12/2/10: From conversation with Amber Market days are twice a week Thurs. and Sat. Missionary Air Sities uses airstrip. ------------------------------------------------- 12/2/10 Email from Amber Munger ...still waiting for verifiable information. The volunteer nurse auxiliary in the La Source Chaude Clinic is refusing to give A29 or the community health committee information on cholera patients because we won't provide him with a salary or other means of compensation. As I mentioned before, the nurse auxiliary is a volunteer that does not have a good relationship with the community but is the only medical personnel that the community has. The Communal Director for MSPP (Dr. Carlo) is meeting with the community health committee, community leadership council, A29, and the nurse auxiliary on Friday to resolve the issue. A29's coordinator, Hebert Pierre, at this point can only verify the number of patients that he has seen at the clinic while he has been present in La Source for the last week. In general, the La Source Chaude clinic has had about 15-19 overnight cholera patients per day for the last five days at the CTC. We can confirm, too, that MSF ( I actually think she meant to say MSPP and had told me they also brought a tent)brought 9 boxes of supplies, (presumably hydration fluid) to the La Source Chaude clinic yesterday. After the meeting on Friday I will be able to give an inventory report on what was given. In terms of the Town of Anse Rouge, as I mentioned before, Hebert said that that clinic is closed. When he went to the clinic again on Tuesday to get information there was only a guardian there who could not provide him with any information. He is hoping to establish more formalised lines of communication today and tomorrow as he meets with CARE - who contacted him yesterday - and MSPP on Friday at the community meeting. ------------------------------------------- 11/22/10 Notes from Amber Hebert has not yet even met with the organization in PAP to know what supplies we will get . That appointment is at 10:00 today. The we still ahve to figure out transport for the supplies. As soon as we receive supplies I will let you know. These supplies will be for the La SOurce Chaude clinic FIRST and anything we can spare we will give to teh CIty Clinic. The City Clinic is on Route National One and patients can more easily find transport to Gonaives from that Center. That is not the case where we are in La SOurce Chaude. We need to have supplies at the La SOurce Chaude clinic because those people will not be able to make it to another location easily. It was a blessing that MSPP had a truck available to send to La Source last time. I dont think our luck wil be the same next time around. Water - the La Source Chaude clinic has water as we have hot springs in la Source Chaude (which means, in French, "hot spring"). The nurse auxillary who works there is highly incompetent and does not use the water filter that was set up for the clinic because he does not like the person who installed it. If he decided to use it again it has to be reinstalled and will be at least a few weeks before it is up and running. So we need aquatab or other water disinfectant for the clinic (as well as for the population in general). ---------------------------------------------- 11/21/10 Update on Assessment from Amber Munger When did cholera patients begin to come at this location? 9 or 10 November How many people does your facility serve? There are approximately 37,000 people in Commune Anse Rouge. Normally, the La SOurce Chaude clinic services about 1/6 of the population. Now that all other clinics except the one in the City of Anse Rouge have closed, people are coming from throughout the commune to the La Source Chaude clinic. Current Cholera Patient Load Up until November 18th there were only five cases (all of whom died). However, yesterday 63 patients walked or were transported to the La Source Chaude clinic many of them walking from extremely remote locations where they were expected to have brought cholera from Port-de-Paix. Most of the patients were coming from Tante, Yaya and Bonsinye, extremely high mountain regions that border third section Port-de-Paix. Fatality Rate for Cholera? Five of the five patients who had cholera until November 18th died; one is suspected of intentionally polluting the water source when he was shut out of the clinics, spreading cholera to three other people in the village of Kay Felip. Yesterday, November 20th one patient died and then 63 more people proceeded arrive at teh clinic. These people were transported in a MSPP truck to Gonaives. No one died en route but we are unclear as to what happened after they were deposited in Gonaives. Has number of patients stabilized? Today there were only seven patients in total. Yesterday was market day and people came from very far to the La Source market, explaining the huge increase in numbers. Medical Staffing (eg. no. of Doctors, no. of Nurses, no. of non medical staff): The community health clinic has no paid staff. There is only a volunteer nurse auxillary at the clinic. There are no qualified medical proffessionals (doctors or nurses) in the entire second section Commune Anse Rouge and only one that we know of in the first section. How many patients are you treating daily? Will update in a few days. How many hospitalized? Just transported all patients Does your facility provide Mobile Medical Clinics to the community?we do not have transportation available What is your Cholera Bed Capacity? There were only five beds in the La SOurce clinic. MSPP sent a tent for the clinic to set up in the lakou but have not provided beds. Describe accessibility to your site (e.g. Passable roads? Helicopter Landing Pad or spot? Airstrip for small planes? Please provide conditions for air landings and GPS coordinates). By road, it is a 2 hour trip from Gonaives (one hour on route national one and another hour on teh road from Letan to La Source Chaude). It is a very difficult road, even by Haiti standards. There is a helicopter landing strip in the City of Anse Rouge, which is a one hour drive from La Source Chaude, but is a much easier drive than the trip from Gonaives. Can you pick up supplies? We can pay local trucks to retrieve the supplies. THe local leaders in the community will offer the use of their large transport vehicles. Medical Supply needs (List by PRIORITY please). cholera related supplies and disinfectants. The clinic is also lacking in basic antibiotics for most other treatable illnesses. ---------------------------------------- 11/21/10 Email from Amber Hi folks - Just a quick update on this. Yesterday 63 patients showed up at the La Sources Chaude clinic after noon because all other clinics in Commune Anse Rouge (except for the one in the City of Anse Rouge) closed their doors to cholera patients. A29 Coordinator lobbied MSPP in Gonaives for help. In response, MSPP sent a truck to La Source Chaude to transport the 63 patients to Gonaives. Our coordinator said there were only a few patients who came to the La Source Clinic this morning before he left for PAP to try to seek medical supplies. MSPP sent us some fluid and IVs as well as a tent to set up a CTC in the lakou of the La Sous Clinic. The supplies will not last long. Hebert is in PAP meeting with Americare to see if they would be willing to give us free antibiotics, fluids, clorox for disinfecting the center, and aquatab. As I mentioned before, there are no qualified medical personnel in second section Commune Anse Rouge, and I am not sure that there are any either in the first section either (other than the regional director, who is helping to coordinate rather than see patients). ----------------------------------------- 11/21/10 Email from Amber I am on a call until 8:00 when I will get back to this but for now I wanted to make clear that A29 does not represent the ILODEP clinic. A29 is trying to find support for the community clinics - not the private clinic run by a private organization. I just received word that even the ILODEP clinic closed, just as all of the other private clinics. The private clinics will not accept cholera patients. Since I last wrote you yesterday, the La SOurce Chaude clinic received 63 patients - because all of the other clinics in the entire commune closed except for the City of Anse Rouge clinic which has no materials. Since the La SOurce Chaude clinic also had no materials, our coordinator Hebert Pierre worked with the Ministry of Health to try to find transport to Gonaives for all 63 of the patients. Gonaives is a treacherous two hour drive from La Source Chaude, and not many vehicles make the voyage. I will fill out the information on the sheet that you sent me just as soon as I am off the call with my board. Thanks for your help! ------------------------------------------- 11/21/10 Have requested Assesment information from Amber for clinic. lpar ------------------------------------------- Email from Amber Munger of Article 29 Organization 11/21/10 Commune Anse Rouge has approximately 37,000 residents but also services parts of Terre Neuve, raising the number to about 42,000. Article 29 Organization's base is in Second Section Commune Anse Rouge, which has four physical health clinics. One is the ILODEP clinic sponsored by Parole et Action, the other three are community clinics which have no paid staff and have not received supplies since July, the last time that A29 secured supplies for distribution to the clinics. There is no doctor or nurse in second section Commune Anse Rouge. There is rumored to be a doctor present in the City of Anse Rouge at the tent clinic (in first section Commune Anse Rouge) at the site of the old hospital that burnt down last year. This clinic is between a 2 to 8 hour walk for people in Second Section Commune Anse Rouge and there are virtually no taptaps or cars in the region. Cholera first entered Second Section Commune Anse Rouge about two weeks ago with cases coming in from people who had been in Gonaives. In second Section Commune Anse Rouge, we had five cases last week. The La Source Chaude clinic, which is the main clinic for the second section and is run by a volunteer nurse auxillary, closed its doors for fear of cholera. All five cholera victims died. A29's coordinator lobbied regional MSPP to re-open the clinic, which the volunteer nurse auxillary has now done, but there are currently no supplies (IV's, hydration fluids, antibiotics) to treat patients. Thus, more patients have arrived at the clinic, receive a cholera diagnosis, and then die. By the time the patients arrive at the clinic they have been too far along to respond to ORS, so IVs are needed. There are very few cars in the region so it is difficult to get patients to the City of Anse Rouge clinic, which as of yesterday was also out of IVs and rehydration fluids. As of yesterday, at least five more cholera patients found transport from SEcond Section Commune Anse Rouge to the City of Anse Rouge clinic in the first section. Two more died at the La Source Chaude clinic in Second Section. Five new patients had arrived at the La Source Clinic yesterday. A29 launched a public education and prevention campaign two weeks ago at teh regions two largest public markets (the City of Anse Rouge and the La Source Chaude markets). Information is spread by megaphone regarding prevention of cholera, treatment and how and when to make ORS. As a result of the outbreak in Gonaives, people are afraid to go to Gonaives for fear of contracting cholera. This puts the entire region in a precarious position as most of the region's supplies are procured in Gonaives (rice, oil, gas, everything). Commune Anse Rouge produces shallot and sourghum and pwa congo but no other crops in sufficient quantity to meet people's basic dietary needs - everything comes from Gonaives. There have been reports that one of the first two cholera victims in the region, when being shut out by the clinic and the community, deliberately polluted the drinking water source in Kay Felip, causing the other three people (of the initial five people) to contract cholera. There is a lot of panic and fear as a result, which could all easily be assuaged with the presence of a qualified doctor or nurse and some cholera medical supplies. A29 is currently engaged in efforts to secure supplies and transport for cholera treatment from PAP but has met with great challenges thus far. A29 is also attempting to engage medical teams to bring support to the region, which almost never receives such assistance because of its isolated location NW of Gonaives.

mission: This is a community clinic and only recieves support from MSPP. Article 29 Organization which is our POC supports clinics by connecting them with resources from other orgs. Amber Munger is pretty much the only English speaking person in the area. Everyone else Kreyol. -> This is a community clinic and only recieves support from MSPP. Article 29 Organization which is our POC supports clinics by connecting them with resources from other orgs. Amber Munger is pretty much the only English speaking person in the area. Everyone else Kreyol. HOUSING FOR MEDICAL VOLUNTEERS: Medical volunteers can stay at the A29 house, which is a 3 bedroom. There are 5 beds there , only two of which are comfortable. I have a solar panel so there is enough energy for a light at night and a fan. I have a modern stove at the house and a water filter. I usually share cooking with Madame Raymond - but they would have their choice of having Madame Raymond cook for them (at a very cheap price), cooking for themselves, or eating at Ti-Paul's restaurant down the street -very greasy but tolerable nonetheless. Madame raymond and her daughter bring water to the house when the pipe that brings water to our yard is broke, which is almost always. But they make sure that there is plenty of water to drink, bathe and wash dishes. There is also a Haitian guesthouse down the street from the clinic. I only recommend it for eating - not for staying as it is very noisy, there is no privacy, and there is no one who speaks English

address: Second Section Commune -> Second Section Commune Helicopter Coord. next to clinic 19 degrees 37'51.49" N 72 degrees 55'07.19" W

notes: 11/21/10 Update on Assessment from Amber Munger When did cholera patients begin to come at this location? 9 or 10 November How many people does your facility serve? There are approximately 37,000 people in Commune Anse Rouge. Normally, the La SOurce Chaude clinic services about 1/6 of the population. Now that all other clinics except the one in the City of Anse Rouge have closed, people are coming from throughout the commune to the La Source Chaude clinic. Current Cholera Patient Load Up until November 18th there were only five cases (all of whom died). However, yesterday 63 patients walked or were transported to the La Source Chaude clinic many of them walking from extremely remote locations where they were expected to have brought cholera from Port-de-Paix. Most of the patients were coming from Tante, Yaya and Bonsinye, extremely high mountain regions that border third section Port-de-Paix. Fatality Rate for Cholera? Five of the five patients who had cholera until November 18th died; one is suspected of intentionally polluting the water source when he was shut out of the clinics, spreading cholera to three other people in the village of Kay Felip. Yesterday, November 20th one patient died and then 63 more people proceeded arrive at teh clinic. These people were transported in a MSPP truck to Gonaives. No one died en route but we are unclear as to what happened after they were deposited in Gonaives. Has number of patients stabilized? Today there were only seven patients in total. Yesterday was market day and people came from very far to the La Source market, explaining the huge increase in numbers. Medical Staffing (eg. no. of Doctors, no. of Nurses, no. of non medical staff): The community health clinic has no paid staff. There is only a volunteer nurse auxillary at the clinic. There are no qualified medical proffessionals (doctors or nurses) in the entire second section Commune Anse Rouge and only one that we know of in the first section. How many patients are you treating daily? Will update in a few days. How many hospitalized? Just transported all patients Does your facility provide Mobile Medical Clinics to the community?we do not have transportation available What is your Cholera Bed Capacity? There were only five beds in the La SOurce clinic. MSPP sent a tent for the clinic to set up in the lakou but have not provided beds. Describe accessibility to your site (e.g. Passable roads? Helicopter Landing Pad or spot? Airstrip for small planes? Please provide conditions for air landings and GPS coordinates). By road, it is a 2 hour trip from Gonaives (one hour on route national one and another hour on teh road from Letan to La Source Chaude). It is a very difficult road, even by Haiti standards. There is a helicopter landing strip in the City of Anse Rouge, which is a one hour drive from La Source Chaude, but is a much easier drive than the trip from Gonaives. Can you pick up supplies? We can pay local trucks to retrieve the supplies. THe local leaders in the community will offer the use of their large transport vehicles. Medical Supply needs (List by PRIORITY please). cholera related supplies and disinfectants. The clinic is also lacking in basic antibiotics for most other treatable illnesses. ---------------------------------------- 11/21/10 Email from Amber Hi folks - Just a quick update on this. Yesterday 63 patients showed up at the La Sources Chaude clinic after noon because all other clinics in Commune Anse Rouge (except for the one in the City of Anse Rouge) closed their doors to cholera patients. A29 Coordinator lobbied MSPP in Gonaives for help. In response, MSPP sent a truck to La Source Chaude to transport the 63 patients to Gonaives. Our coordinator said there were only a few patients who came to the La Source Clinic this morning before he left for PAP to try to seek medical supplies. MSPP sent us some fluid and IVs as well as a tent to set up a CTC in the lakou of the La Sous Clinic. The supplies will not last long. Hebert is in PAP meeting with Americare to see if they would be willing to give us free antibiotics, fluids, clorox for disinfecting the center, and aquatab. As I mentioned before, there are no qualified medical personnel in second section Commune Anse Rouge, and I am not sure that there are any either in the first section either (other than the regional director, who is helping to coordinate rather than see patients). ----------------------------------------- 11/21/10 Email from Amber I am on a call until 8:00 when I will get back to this but for now I wanted to make clear that A29 does not represent the ILODEP clinic. A29 is trying to find support for the community clinics - not the private clinic run by a private organization. I just received word that even the ILODEP clinic closed, just as all of the other private clinics. The private clinics will not accept cholera patients. Since I last wrote you yesterday, the La SOurce Chaude clinic received 63 patients - because all of the other clinics in the entire commune closed except for the City of Anse Rouge clinic which has no materials. Since the La SOurce Chaude clinic also had no materials, our coordinator Hebert Pierre worked with the Ministry of Health to try to find transport to Gonaives for all 63 of the patients. Gonaives is a treacherous two hour drive from La Source Chaude, and not many vehicles make the voyage. I will fill out the information on the sheet that you sent me just as soon as I am off the call with my board. Thanks for your help! ------------------------------------------- 11/21/10 Have requested Assesment information from Amber for clinic. lpar ------------------------------------------- Email from Amber Munger of Article 29 Organization 11/21/10 Commune Anse Rouge has approximately 37,000 residents but also services parts of Terre Neuve, raising the number to about 42,000. Article 29 Organization's base is in Second Section Commune Anse Rouge, which has four physical health clinics. One is the ILODEP clinic sponsored by Parole et Action, the other three are community clinics which have no paid staff and have not received supplies since July, the last time that A29 secured supplies for distribution to the clinics. There is no doctor or nurse in second section Commune Anse Rouge. There is rumored to be a doctor present in the City of Anse Rouge at the tent clinic (in first section Commune Anse Rouge) at the site of the old hospital that burnt down last year. This clinic is between a 2 to 8 hour walk for people in Second Section Commune Anse Rouge and there are virtually no taptaps or cars in the region. Cholera first entered Second Section Commune Anse Rouge about two weeks ago with cases coming in from people who had been in Gonaives. In second Section Commune Anse Rouge, we had five cases last week. The La Source Chaude clinic, which is the main clinic for the second section and is run by a volunteer nurse auxillary, closed its doors for fear of cholera. All five cholera victims died. A29's coordinator lobbied regional MSPP to re-open the clinic, which the volunteer nurse auxillary has now done, but there are currently no supplies (IV's, hydration fluids, antibiotics) to treat patients. Thus, more patients have arrived at the clinic, receive a cholera diagnosis, and then die. By the time the patients arrive at the clinic they have been too far along to respond to ORS, so IVs are needed. There are very few cars in the region so it is difficult to get patients to the City of Anse Rouge clinic, which as of yesterday was also out of IVs and rehydration fluids. As of yesterday, at least five more cholera patients found transport from SEcond Section Commune Anse Rouge to the City of Anse Rouge clinic in the first section. Two more died at the La Source Chaude clinic in Second Section. Five new patients had arrived at the La Source Clinic yesterday. A29 launched a public education and prevention campaign two weeks ago at teh regions two largest public markets (the City of Anse Rouge and the La Source Chaude markets). Information is spread by megaphone regarding prevention of cholera, treatment and how and when to make ORS. As a result of the outbreak in Gonaives, people are afraid to go to Gonaives for fear of contracting cholera. This puts the entire region in a precarious position as most of the region's supplies are procured in Gonaives (rice, oil, gas, everything). Commune Anse Rouge produces shallot and sourghum and pwa congo but no other crops in sufficient quantity to meet people's basic dietary needs - everything comes from Gonaives. There have been reports that one of the first two cholera victims in the region, when being shut out by the clinic and the community, deliberately polluted the drinking water source in Kay Felip, causing the other three people (of the initial five people) to contract cholera. There is a lot of panic and fear as a result, which could all easily be assuaged with the presence of a qualified doctor or nurse and some cholera medical supplies. A29 is currently engaged in efforts to secure supplies and transport for cholera treatment from PAP but has met with great challenges thus far. A29 is also attempting to engage medical teams to bring support to the region, which almost never receives such assistance because of its isolated location NW of Gonaives. -> 11/22/10 Notes from Amber Hebert has not yet even met with the organization in PAP to know what supplies we will get . That appointment is at 10:00 today. The we still ahve to figure out transport for the supplies. As soon as we receive supplies I will let you know. These supplies will be for the La SOurce Chaude clinic FIRST and anything we can spare we will give to teh CIty Clinic. The City Clinic is on Route National One and patients can more easily find transport to Gonaives from that Center. That is not the case where we are in La SOurce Chaude. We need to have supplies at the La SOurce Chaude clinic because those people will not be able to make it to another location easily. It was a blessing that MSPP had a truck available to send to La Source last time. I dont think our luck wil be the same next time around. Water - the La Source Chaude clinic has water as we have hot springs in la Source Chaude (which means, in French, "hot spring"). The nurse auxillary who works there is highly incompetent and does not use the water filter that was set up for the clinic because he does not like the person who installed it. If he decided to use it again it has to be reinstalled and will be at least a few weeks before it is up and running. So we need aquatab or other water disinfectant for the clinic (as well as for the population in general). 11/21/10 Update on Assessment from Amber Munger When did cholera patients begin to come at this location? 9 or 10 November How many people does your facility serve? There are approximately 37,000 people in Commune Anse Rouge. Normally, the La SOurce Chaude clinic services about 1/6 of the population. Now that all other clinics except the one in the City of Anse Rouge have closed, people are coming from throughout the commune to the La Source Chaude clinic. Current Cholera Patient Load Up until November 18th there were only five cases (all of whom died). However, yesterday 63 patients walked or were transported to the La Source Chaude clinic many of them walking from extremely remote locations where they were expected to have brought cholera from Port-de-Paix. Most of the patients were coming from Tante, Yaya and Bonsinye, extremely high mountain regions that border third section Port-de-Paix. Fatality Rate for Cholera? Five of the five patients who had cholera until November 18th died; one is suspected of intentionally polluting the water source when he was shut out of the clinics, spreading cholera to three other people in the village of Kay Felip. Yesterday, November 20th one patient died and then 63 more people proceeded arrive at teh clinic. These people were transported in a MSPP truck to Gonaives. No one died en route but we are unclear as to what happened after they were deposited in Gonaives. Has number of patients stabilized? Today there were only seven patients in total. Yesterday was market day and people came from very far to the La Source market, explaining the huge increase in numbers. Medical Staffing (eg. no. of Doctors, no. of Nurses, no. of non medical staff): The community health clinic has no paid staff. There is only a volunteer nurse auxillary at the clinic. There are no qualified medical proffessionals (doctors or nurses) in the entire second section Commune Anse Rouge and only one that we know of in the first section. How many patients are you treating daily? Will update in a few days. How many hospitalized? Just transported all patients Does your facility provide Mobile Medical Clinics to the community?we do not have transportation available What is your Cholera Bed Capacity? There were only five beds in the La SOurce clinic. MSPP sent a tent for the clinic to set up in the lakou but have not provided beds. Describe accessibility to your site (e.g. Passable roads? Helicopter Landing Pad or spot? Airstrip for small planes? Please provide conditions for air landings and GPS coordinates). By road, it is a 2 hour trip from Gonaives (one hour on route national one and another hour on teh road from Letan to La Source Chaude). It is a very difficult road, even by Haiti standards. There is a helicopter landing strip in the City of Anse Rouge, which is a one hour drive from La Source Chaude, but is a much easier drive than the trip from Gonaives. Can you pick up supplies? We can pay local trucks to retrieve the supplies. THe local leaders in the community will offer the use of their large transport vehicles. Medical Supply needs (List by PRIORITY please). cholera related supplies and disinfectants. The clinic is also lacking in basic antibiotics for most other treatable illnesses. ---------------------------------------- 11/21/10 Email from Amber Hi folks - Just a quick update on this. Yesterday 63 patients showed up at the La Sources Chaude clinic after noon because all other clinics in Commune Anse Rouge (except for the one in the City of Anse Rouge) closed their doors to cholera patients. A29 Coordinator lobbied MSPP in Gonaives for help. In response, MSPP sent a truck to La Source Chaude to transport the 63 patients to Gonaives. Our coordinator said there were only a few patients who came to the La Source Clinic this morning before he left for PAP to try to seek medical supplies. MSPP sent us some fluid and IVs as well as a tent to set up a CTC in the lakou of the La Sous Clinic. The supplies will not last long. Hebert is in PAP meeting with Americare to see if they would be willing to give us free antibiotics, fluids, clorox for disinfecting the center, and aquatab. As I mentioned before, there are no qualified medical personnel in second section Commune Anse Rouge, and I am not sure that there are any either in the first section either (other than the regional director, who is helping to coordinate rather than see patients). ----------------------------------------- 11/21/10 Email from Amber I am on a call until 8:00 when I will get back to this but for now I wanted to make clear that A29 does not represent the ILODEP clinic. A29 is trying to find support for the community clinics - not the private clinic run by a private organization. I just received word that even the ILODEP clinic closed, just as all of the other private clinics. The private clinics will not accept cholera patients. Since I last wrote you yesterday, the La SOurce Chaude clinic received 63 patients - because all of the other clinics in the entire commune closed except for the City of Anse Rouge clinic which has no materials. Since the La SOurce Chaude clinic also had no materials, our coordinator Hebert Pierre worked with the Ministry of Health to try to find transport to Gonaives for all 63 of the patients. Gonaives is a treacherous two hour drive from La Source Chaude, and not many vehicles make the voyage. I will fill out the information on the sheet that you sent me just as soon as I am off the call with my board. Thanks for your help! ------------------------------------------- 11/21/10 Have requested Assesment information from Amber for clinic. lpar ------------------------------------------- Email from Amber Munger of Article 29 Organization 11/21/10 Commune Anse Rouge has approximately 37,000 residents but also services parts of Terre Neuve, raising the number to about 42,000. Article 29 Organization's base is in Second Section Commune Anse Rouge, which has four physical health clinics. One is the ILODEP clinic sponsored by Parole et Action, the other three are community clinics which have no paid staff and have not received supplies since July, the last time that A29 secured supplies for distribution to the clinics. There is no doctor or nurse in second section Commune Anse Rouge. There is rumored to be a doctor present in the City of Anse Rouge at the tent clinic (in first section Commune Anse Rouge) at the site of the old hospital that burnt down last year. This clinic is between a 2 to 8 hour walk for people in Second Section Commune Anse Rouge and there are virtually no taptaps or cars in the region. Cholera first entered Second Section Commune Anse Rouge about two weeks ago with cases coming in from people who had been in Gonaives. In second Section Commune Anse Rouge, we had five cases last week. The La Source Chaude clinic, which is the main clinic for the second section and is run by a volunteer nurse auxillary, closed its doors for fear of cholera. All five cholera victims died. A29's coordinator lobbied regional MSPP to re-open the clinic, which the volunteer nurse auxillary has now done, but there are currently no supplies (IV's, hydration fluids, antibiotics) to treat patients. Thus, more patients have arrived at the clinic, receive a cholera diagnosis, and then die. By the time the patients arrive at the clinic they have been too far along to respond to ORS, so IVs are needed. There are very few cars in the region so it is difficult to get patients to the City of Anse Rouge clinic, which as of yesterday was also out of IVs and rehydration fluids. As of yesterday, at least five more cholera patients found transport from SEcond Section Commune Anse Rouge to the City of Anse Rouge clinic in the first section. Two more died at the La Source Chaude clinic in Second Section. Five new patients had arrived at the La Source Clinic yesterday. A29 launched a public education and prevention campaign two weeks ago at teh regions two largest public markets (the City of Anse Rouge and the La Source Chaude markets). Information is spread by megaphone regarding prevention of cholera, treatment and how and when to make ORS. As a result of the outbreak in Gonaives, people are afraid to go to Gonaives for fear of contracting cholera. This puts the entire region in a precarious position as most of the region's supplies are procured in Gonaives (rice, oil, gas, everything). Commune Anse Rouge produces shallot and sourghum and pwa congo but no other crops in sufficient quantity to meet people's basic dietary needs - everything comes from Gonaives. There have been reports that one of the first two cholera victims in the region, when being shut out by the clinic and the community, deliberately polluted the drinking water source in Kay Felip, causing the other three people (of the initial five people) to contract cholera. There is a lot of panic and fear as a result, which could all easily be assuaged with the presence of a qualified doctor or nurse and some cholera medical supplies. A29 is currently engaged in efforts to secure supplies and transport for cholera treatment from PAP but has met with great challenges thus far. A29 is also attempting to engage medical teams to bring support to the region, which almost never receives such assistance because of its isolated location NW of Gonaives.

name: La Source Chaude Clinic "Cholera Treatment Center - CTC" - STANDBY -> Community Clinic La Source Chaude "Cholera Treatment Center - CTC" - (MSPP) STANDBY
mgt_contact changed.
mgt_phone changed.
notes: 11/21/10 Email from Amber Hi folks - Just a quick update on this. Yesterday 63 patients showed up at the La Sources Chaude clinic after noon because all other clinics in Commune Anse Rouge (except for the one in the City of Anse Rouge) closed their doors to cholera patients. A29 Coordinator lobbied MSPP in Gonaives for help. In response, MSPP sent a truck to La Source Chaude to transport the 63 patients to Gonaives. Our coordinator said there were only a few patients who came to the La Source Clinic this morning before he left for PAP to try to seek medical supplies. MSPP sent us some fluid and IVs as well as a tent to set up a CTC in the lakou of the La Sous Clinic. The supplies will not last long. Hebert is in PAP meeting with Americare to see if they would be willing to give us free antibiotics, fluids, clorox for disinfecting the center, and aquatab. As I mentioned before, there are no qualified medical personnel in second section Commune Anse Rouge, and I am not sure that there are any either in the first section either (other than the regional director, who is helping to coordinate rather than see patients). ----------------------------------------- 11/21/10 Email from Amber I am on a call until 8:00 when I will get back to this but for now I wanted to make clear that A29 does not represent the ILODEP clinic. A29 is trying to find support for the community clinics - not the private clinic run by a private organization. I just received word that even the ILODEP clinic closed, just as all of the other private clinics. The private clinics will not accept cholera patients. Since I last wrote you yesterday, the La SOurce Chaude clinic received 63 patients - because all of the other clinics in the entire commune closed except for the City of Anse Rouge clinic which has no materials. Since the La SOurce Chaude clinic also had no materials, our coordinator Hebert Pierre worked with the Ministry of Health to try to find transport to Gonaives for all 63 of the patients. Gonaives is a treacherous two hour drive from La Source Chaude, and not many vehicles make the voyage. I will fill out the information on the sheet that you sent me just as soon as I am off the call with my board. Thanks for your help! ------------------------------------------- 11/21/10 Have requested Assesment information from Amber for clinic. lpar ------------------------------------------- Email from Amber Munger of Article 29 Organization 11/21/10 Commune Anse Rouge has approximately 37,000 residents but also services parts of Terre Neuve, raising the number to about 42,000. Article 29 Organization's base is in Second Section Commune Anse Rouge, which has four physical health clinics. One is the ILODEP clinic sponsored by Parole et Action, the other three are community clinics which have no paid staff and have not received supplies since July, the last time that A29 secured supplies for distribution to the clinics. There is no doctor or nurse in second section Commune Anse Rouge. There is rumored to be a doctor present in the City of Anse Rouge at the tent clinic (in first section Commune Anse Rouge) at the site of the old hospital that burnt down last year. This clinic is between a 2 to 8 hour walk for people in Second Section Commune Anse Rouge and there are virtually no taptaps or cars in the region. Cholera first entered Second Section Commune Anse Rouge about two weeks ago with cases coming in from people who had been in Gonaives. In second Section Commune Anse Rouge, we had five cases last week. The La Source Chaude clinic, which is the main clinic for the second section and is run by a volunteer nurse auxillary, closed its doors for fear of cholera. All five cholera victims died. A29's coordinator lobbied regional MSPP to re-open the clinic, which the volunteer nurse auxillary has now done, but there are currently no supplies (IV's, hydration fluids, antibiotics) to treat patients. Thus, more patients have arrived at the clinic, receive a cholera diagnosis, and then die. By the time the patients arrive at the clinic they have been too far along to respond to ORS, so IVs are needed. There are very few cars in the region so it is difficult to get patients to the City of Anse Rouge clinic, which as of yesterday was also out of IVs and rehydration fluids. As of yesterday, at least five more cholera patients found transport from SEcond Section Commune Anse Rouge to the City of Anse Rouge clinic in the first section. Two more died at the La Source Chaude clinic in Second Section. Five new patients had arrived at the La Source Clinic yesterday. A29 launched a public education and prevention campaign two weeks ago at teh regions two largest public markets (the City of Anse Rouge and the La Source Chaude markets). Information is spread by megaphone regarding prevention of cholera, treatment and how and when to make ORS. As a result of the outbreak in Gonaives, people are afraid to go to Gonaives for fear of contracting cholera. This puts the entire region in a precarious position as most of the region's supplies are procured in Gonaives (rice, oil, gas, everything). Commune Anse Rouge produces shallot and sourghum and pwa congo but no other crops in sufficient quantity to meet people's basic dietary needs - everything comes from Gonaives. There have been reports that one of the first two cholera victims in the region, when being shut out by the clinic and the community, deliberately polluted the drinking water source in Kay Felip, causing the other three people (of the initial five people) to contract cholera. There is a lot of panic and fear as a result, which could all easily be assuaged with the presence of a qualified doctor or nurse and some cholera medical supplies. A29 is currently engaged in efforts to secure supplies and transport for cholera treatment from PAP but has met with great challenges thus far. A29 is also attempting to engage medical teams to bring support to the region, which almost never receives such assistance because of its isolated location NW of Gonaives. -> 11/21/10 Update on Assessment from Amber Munger When did cholera patients begin to come at this location? 9 or 10 November How many people does your facility serve? There are approximately 37,000 people in Commune Anse Rouge. Normally, the La SOurce Chaude clinic services about 1/6 of the population. Now that all other clinics except the one in the City of Anse Rouge have closed, people are coming from throughout the commune to the La Source Chaude clinic. Current Cholera Patient Load Up until November 18th there were only five cases (all of whom died). However, yesterday 63 patients walked or were transported to the La Source Chaude clinic many of them walking from extremely remote locations where they were expected to have brought cholera from Port-de-Paix. Most of the patients were coming from Tante, Yaya and Bonsinye, extremely high mountain regions that border third section Port-de-Paix. Fatality Rate for Cholera? Five of the five patients who had cholera until November 18th died; one is suspected of intentionally polluting the water source when he was shut out of the clinics, spreading cholera to three other people in the village of Kay Felip. Yesterday, November 20th one patient died and then 63 more people proceeded arrive at teh clinic. These people were transported in a MSPP truck to Gonaives. No one died en route but we are unclear as to what happened after they were deposited in Gonaives. Has number of patients stabilized? Today there were only seven patients in total. Yesterday was market day and people came from very far to the La Source market, explaining the huge increase in numbers. Medical Staffing (eg. no. of Doctors, no. of Nurses, no. of non medical staff): The community health clinic has no paid staff. There is only a volunteer nurse auxillary at the clinic. There are no qualified medical proffessionals (doctors or nurses) in the entire second section Commune Anse Rouge and only one that we know of in the first section. How many patients are you treating daily? Will update in a few days. How many hospitalized? Just transported all patients Does your facility provide Mobile Medical Clinics to the community?we do not have transportation available What is your Cholera Bed Capacity? There were only five beds in the La SOurce clinic. MSPP sent a tent for the clinic to set up in the lakou but have not provided beds. Describe accessibility to your site (e.g. Passable roads? Helicopter Landing Pad or spot? Airstrip for small planes? Please provide conditions for air landings and GPS coordinates). By road, it is a 2 hour trip from Gonaives (one hour on route national one and another hour on teh road from Letan to La Source Chaude). It is a very difficult road, even by Haiti standards. There is a helicopter landing strip in the City of Anse Rouge, which is a one hour drive from La Source Chaude, but is a much easier drive than the trip from Gonaives. Can you pick up supplies? We can pay local trucks to retrieve the supplies. THe local leaders in the community will offer the use of their large transport vehicles. Medical Supply needs (List by PRIORITY please). cholera related supplies and disinfectants. The clinic is also lacking in basic antibiotics for most other treatable illnesses. ---------------------------------------- 11/21/10 Email from Amber Hi folks - Just a quick update on this. Yesterday 63 patients showed up at the La Sources Chaude clinic after noon because all other clinics in Commune Anse Rouge (except for the one in the City of Anse Rouge) closed their doors to cholera patients. A29 Coordinator lobbied MSPP in Gonaives for help. In response, MSPP sent a truck to La Source Chaude to transport the 63 patients to Gonaives. Our coordinator said there were only a few patients who came to the La Source Clinic this morning before he left for PAP to try to seek medical supplies. MSPP sent us some fluid and IVs as well as a tent to set up a CTC in the lakou of the La Sous Clinic. The supplies will not last long. Hebert is in PAP meeting with Americare to see if they would be willing to give us free antibiotics, fluids, clorox for disinfecting the center, and aquatab. As I mentioned before, there are no qualified medical personnel in second section Commune Anse Rouge, and I am not sure that there are any either in the first section either (other than the regional director, who is helping to coordinate rather than see patients). ----------------------------------------- 11/21/10 Email from Amber I am on a call until 8:00 when I will get back to this but for now I wanted to make clear that A29 does not represent the ILODEP clinic. A29 is trying to find support for the community clinics - not the private clinic run by a private organization. I just received word that even the ILODEP clinic closed, just as all of the other private clinics. The private clinics will not accept cholera patients. Since I last wrote you yesterday, the La SOurce Chaude clinic received 63 patients - because all of the other clinics in the entire commune closed except for the City of Anse Rouge clinic which has no materials. Since the La SOurce Chaude clinic also had no materials, our coordinator Hebert Pierre worked with the Ministry of Health to try to find transport to Gonaives for all 63 of the patients. Gonaives is a treacherous two hour drive from La Source Chaude, and not many vehicles make the voyage. I will fill out the information on the sheet that you sent me just as soon as I am off the call with my board. Thanks for your help! ------------------------------------------- 11/21/10 Have requested Assesment information from Amber for clinic. lpar ------------------------------------------- Email from Amber Munger of Article 29 Organization 11/21/10 Commune Anse Rouge has approximately 37,000 residents but also services parts of Terre Neuve, raising the number to about 42,000. Article 29 Organization's base is in Second Section Commune Anse Rouge, which has four physical health clinics. One is the ILODEP clinic sponsored by Parole et Action, the other three are community clinics which have no paid staff and have not received supplies since July, the last time that A29 secured supplies for distribution to the clinics. There is no doctor or nurse in second section Commune Anse Rouge. There is rumored to be a doctor present in the City of Anse Rouge at the tent clinic (in first section Commune Anse Rouge) at the site of the old hospital that burnt down last year. This clinic is between a 2 to 8 hour walk for people in Second Section Commune Anse Rouge and there are virtually no taptaps or cars in the region. Cholera first entered Second Section Commune Anse Rouge about two weeks ago with cases coming in from people who had been in Gonaives. In second Section Commune Anse Rouge, we had five cases last week. The La Source Chaude clinic, which is the main clinic for the second section and is run by a volunteer nurse auxillary, closed its doors for fear of cholera. All five cholera victims died. A29's coordinator lobbied regional MSPP to re-open the clinic, which the volunteer nurse auxillary has now done, but there are currently no supplies (IV's, hydration fluids, antibiotics) to treat patients. Thus, more patients have arrived at the clinic, receive a cholera diagnosis, and then die. By the time the patients arrive at the clinic they have been too far along to respond to ORS, so IVs are needed. There are very few cars in the region so it is difficult to get patients to the City of Anse Rouge clinic, which as of yesterday was also out of IVs and rehydration fluids. As of yesterday, at least five more cholera patients found transport from SEcond Section Commune Anse Rouge to the City of Anse Rouge clinic in the first section. Two more died at the La Source Chaude clinic in Second Section. Five new patients had arrived at the La Source Clinic yesterday. A29 launched a public education and prevention campaign two weeks ago at teh regions two largest public markets (the City of Anse Rouge and the La Source Chaude markets). Information is spread by megaphone regarding prevention of cholera, treatment and how and when to make ORS. As a result of the outbreak in Gonaives, people are afraid to go to Gonaives for fear of contracting cholera. This puts the entire region in a precarious position as most of the region's supplies are procured in Gonaives (rice, oil, gas, everything). Commune Anse Rouge produces shallot and sourghum and pwa congo but no other crops in sufficient quantity to meet people's basic dietary needs - everything comes from Gonaives. There have been reports that one of the first two cholera victims in the region, when being shut out by the clinic and the community, deliberately polluted the drinking water source in Kay Felip, causing the other three people (of the initial five people) to contract cholera. There is a lot of panic and fear as a result, which could all easily be assuaged with the presence of a qualified doctor or nurse and some cholera medical supplies. A29 is currently engaged in efforts to secure supplies and transport for cholera treatment from PAP but has met with great challenges thus far. A29 is also attempting to engage medical teams to bring support to the region, which almost never receives such assistance because of its isolated location NW of Gonaives.
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mission: -> This is a community clinic and only recieves support from MSPP. Article 29 Organization which is our POC supports clinics by connecting them with resources from other orgs. Amber Munger is pretty much the only English speaking person in the area. Everyone else Kreyol.