NGOs tend to “come here and plant their flags and then leave,” Guillet said matter-of-factly, as if our question about water quality maintenance should answer itself.
According to the latest report by the Pan American Health Organization (PAHO), MSF-France will be leaving the Hopital Immaculee de Conception in Port de Paix where they take in about 10 cases of diarrhea a day – mostly non-cholera cases–compared to the 120 to 150 cases they were seeing previously. MSF-France is training the hospital’s staff in order to prepare for their full departure in mid- February.
A recent Haiti Health Cluster Bulletin discussed this issue.
The lack of partners in the North West is a particular concern. Clinical case management was largely carried out by MSF and the CMB… These NGOs continue to support the management of the treatment and rehydration centers (CTC, CTU and ORP). Yet following a reduction in the number of new cases, some partners are beginning to leave the department, including MSF.
Although DINEPA has an office in Port de Paix and has been distributing chlorination tablets (Aquatabs) and soap, Guillet did not know who would continue chlorination of the water supply. He fingered the Blackberry and tried calling Dr. Beauge Laurant, who is the General Director of Health. Laurant was unreachable, but we caught up with him.
Laurant echoed Guillet when we reached him by phone from Port-au-Prince two days later. “They (MSF-France) came with flags, but no assessment,” Laurant said. He termed NGO response to the cholera epidemic and lingering sanitation issues as an “intervention ponctuelle”–a timely intervention with no resolution. A major concern is that there is no water system in Port de Paix and the local government has no ability to chlorinate the water truck used to fill distribution bladders. Fountains come directly from the river source and there is no purification. Water purification tablets are the fallback, and there are not enough of them, or the local population does not have access to them.
Laurant suggested we call the DINEPA office in charge of Nord-Quest. Pierre Bernadin Poisson was our contact at the Technical Center Operations (CTE) /DINEPA office for Port de Paix. He was aware that MSF was leaving on February 28.
The plan was for CTE/DINEPA to take over water purification when MSF left, but “CTE does not have the capability to chlorinate water delivery,” Poisson said. The water source for Port de Paix is the Les Trois Rivieres (Three Rivers River). He noted that there are 41,750 boxes of 200 count Aquatab chlorination tablets in Nord-Quest Department. Each tablet purifies 5 liters of water. Nord-Quest also received 605,002 bars of soap.
Whether those tablets and soap are getting to the population is another matter.After we visited with Mayor Guillet on Sunday, we took a short drive to the city of La Pointe where locals told us they needed Aquatabs and bleach. It turned out that they had to buy tablets from the market and no one had enough money to purchase them. Why donated purification tablets are being sold openly in the “pharmacies” is another question and is beyond the scope of what we were prepared to investigate.
In La Pointe, children were playing and drinking from public fountains that pumped water directly from the river. We asked a man who mixed bleach into the water used at the local hospital why no one was afraid of cholera. He said, erroneously, that cholera lived “in the dust” and that as long as it was not raining there was nothing to worry about, since water “activated the cholera.”
Nowhere could we find the brochures and educational materials about cholera MSPP says it and the NGOs are distributing to the countryside. What we found in La Pointe reflects OCHA’s comment that “There is currently a lack of communications material accompanying the distribution of chlorination products, suitable for people who can not read or write easily.”
We finally spoke with MSF’s Emergency Medical Coordinator, Caroline Seguin, by phone. She confirmed that MSF was leaving Port de Paix, but would continue to “monitor” the cholera situation every two weeks. Some cholera treatment centers would remain staffed, but the NGO would longer treat the water. MSF issued a well-publicized appeal for funding in November, calling upon all NGOs to “step up” their cholera response.
Is now really the time to “step down?”
So what is the solution to this oversight–this “intervention ponctuelle?”
NGOs should stop funding themselves and direct efforts and money to local governments. The latest USAID “fact sheet” says to date $43,476,746 has been earmarked for cholera response, not including the $13.2 million MSF has spent from its own funds.
The mayor of Port de Paix certainly understands the needs of his electorate better than an international NGO. For now, the ability to chlorinate the water truck would be a godsend.
The right to clean water and sanitation is a human right–ironically a right recognized by the United Nations, whose troops inadvertently introduced cholera to Haiti in November.
178 countries have now recognized the right to water and sanitation at least once in an international resolution or declaration. This includes the improvement of all aspects of environmental and industrial hygiene; and the prevention, treatment and control of epidemic, endemic, and other diseases.
Perhaps this should be the first standard imposed upon any organization authorized to accept money on behalf of the Haitian people–grant them their basic human right to clean water.