At the beginning we were vaccinating around 250 people a day, but it´s tapered off to 70 or so,¨ Raysoly Yacob Flores, a Salvadoran nurse trained in Cuba tells me as we set out for the displaced persons camp where the Henry Reeve Contingent will vaccinate all comers. I´ll admit I´m slightly disappointed that I´m catching the tail end of the action. I´ve heard a lot about the massive vaccinations carried out by the Cubans and their ELAM-trained colleagues in the weeks immediately following the earthquake, when multiple teams fanned out through the sprawling encampments that hundreds of thousands of Haitians now call ¨home.¨
But my disappointment is premature: instead of tagging along with Raysoly or the other team to areas where vaccinations have already been initiated, I´m accompanying Cuban nurse (and head of the Port-au-Prince vaccination effort) Esmeris Atiñol to a camp where no one has yet been vaccinated. It should be interesting to watch the team inaugurate a new location. A recent report filed on the blog Haiti: Operational Biosurveillance by Dr James Wilson describes health actions, including vaccinations, at a displaced persons camp in Petionville: ¨when word spread about sore arms and the occasional post-vaccination fever, very few showed up for the 2nd day of vaccinations. Red Cross left the area, leaving a best estimate of only 20 percent of the population vaccinated.¨ Given the limited experience many Haitians have with health care in general and vaccinations specifically, I´m especially anxious to see the community´s reaction to this basic preventative health measure.
Delmas 15 (as it´s called by the Cubans) is formally known as La Place Dame Carrefour Aeroport in the post-quake language of Port-au-Prince. It´s a postage stamp plaza at the city´s major intersection of Rte de Delmas and Blvd T. Louverture where 1,060 people live in donated tents pitched on bare, blazing hot concrete.
Before we´re even beyond the first line of dust-covered tents, nurse Esmeris is chatting up mothers in lyrical Creole, asking if they´ve been vaccinated. Though she hails from the remote Cuban municipality of Tercer Frente in Santiago de Cuba, Esmeris´ forebearers were Haitian and she has been working in Haiti as part of Cuba´s Integral Health Program for the past year. She traverses the divide between Spanish and Creole easily and I can see the relief etched on the mothers´ faces as they converse in their native tongue. They follow this Cuban nurse to the vaccination post eagerly, small children in tow.
¨Post¨ is an exaggeration. Each time the Henry Reeve Contingent initiates vaccinations in a new location, they have to find an accessible (and hopefully shady/rain-proof) location to set up. Luckily, La Place Dame is anchored by a pastel-colored gazebo that overlooks the fenced in camp. The columns are cracked and crumbling from the quake, the rebar laid bare like an open wound, but no matter: its visibility and staircases at either end provide natural patient flow, plus it´s refreshingly sun-free. From nowhere, a pair of clean cut youths, badges of the camp’s organizing committee dangling from their necks, appear carrying two chairs – each with three legs. Seems everything in Haiti these days is a balancing act. Once a table materializes (again I’m amazed at Haitian solidarity – that people so destitute and physically and emotionally battered still have the energy to share both among themselves and with us), the team is set to go to work.
The Henry Reeve Disaster Medicine Contingent currently offers three vaccines: a trivalent DPT (diphtheria, petrussis, and tetanus) for babies one-and-a-half months to eight months old; a DPT/measles/mumps combination, paired with Retinol (Vitamin A) for children nine months to seven years old; and a diphtheria-tetanus duo for everyone eight and over. Once again, the supplies used by the Cuban team represent a kaleidoscope of international health cooperation with vaccines from India, Canada and the WHO Essential Medicines Program; disposable syringes from the United Arab Emirates; and nifty collapsible biohazard safety boxes from Finland.
Conducting an effective vaccination campaign in conditions like those in post-quake Haiti is extraordinarily complex. There are issues related to the vaccines themselves (primarily the maintenance of the cold chain and safe disposal of hazardous biowaste), but also to the particular health culture and context of the host country. And Haiti is as intricate and layered as they come. Fortunately, scores of Cuban health professionals – doctors, nurses, specialists, and technicians – in Port-au-Prince have been serving in Haiti for a year or more as part of Cuba’s Comprehensive Health Program. Veterans on these shores, they exhibit a rare affinity for this astonishingly foreign culture. Importantly, nurse Esmeris and several of her colleagues working on the capital’s vaccination campaign were posted in Gonaïves before the earthquake. There, they vaccinated over 40,000 people between October and January 12, meeting the country’s obligation made to the Pan American Health Organization as part of the national immunization program.
Given all this back story, I shouldn’t be surprised when the trickle of people to be vaccinated turns into a stream and eventually a torrent of the Place de Dame community. A teacher lines up her grade-school class for the free vaccines (school still hasn’t started, but this camp is well organized, with young people especially assuming whatever responsibilities required, like this teacher caring for her out-of-school students), and there are grannies and well-dressed men too – even the camp tough guys are rolling up their sleeves, anticipating the jab with a squint and a smile.
But it’s the work of Elvire Constant that really ratchets up the work flow.
Once she happens on the scene, people start arriving in droves, from other camps and the street even, belying Raysoly’s 70 or so prediction. A strong, wiry woman with the intricate braids favored by many Haitian women, Elvire is president of the organizing committee of a nearby camp where the Cuban teams previously worked. “Thanks to her, we vaccinated that entire camp,” Esmeris tells me. I can see why there has been such great acceptance: Elvire arrives, picks up a bullhorn, presses ‘talk’ and begins singing in a lovely, lilting Creole about the ‘free vaccinations, available here all morning, given by Cuban doctors.’ She threads her way between tents and out to the street calling vendors, office workers, and passers-by to get vaccinated, like some muezzin of better health.
Each person receives a yellow vaccination card with the seal of the Haitian Ministry of Public Health indicating their name, age, and vaccine administered (and schedule of additional shots in the case of DPT). Everything is in Creole and explained by the Cubans with the help of Haitian volunteers who lend a hand wherever the medical teams are found. Today, Jackson Pierre Louis and Gladimir Alexime, members of the Place de Dame camp organizing committee, appear unsolicited to help fill out the yellow cards and explain the procedure. Given the language barrier and the novelty of the vaccination concept (several people from Place de Dame line up for a second vaccination for example), I ask Esmeris how the program is administered. “We keep detailed records of where we’ve been and how many people of each age group we’ve vaccinated. In two months’ time, we’ll re-visit each area to administer second doses for those requiring them. After that the Haitian health system provides the booster shots.” I raise an eyebrow at this last part, given that the public health system is in such disarray. She tells me that´s the ideal. Still, there is hope: the Haitian government and the Bolivarian Alliance for the People of the Americas (ALBA) presented a plan for reconstructing the Haitian health system to the World Health Organization last week. In today´s Haiti, it´s imperative that such ideals get translated into realities.
In the meantime, the work of the Cuban teams takes on increasing urgency as the rainy season approaches, says Dr Jorge Pérez, Director of the hospital at Cuba´s Pedro Kourí Institute for Tropical Medicine, Cuba´s reference center for infectious diseases. In Haiti to conduct an epidemiological assessment, Dr Pérez told me vaccination, health promotion and prevention are the most important tasks right now. ¨It´s important to be vigilant. The epidemiological picture is going to get much more complicated when the rains come.¨
With this in mind, the Cuban health professionals, accompanied by graduates of the Latin American Medical School, and innumerable Haitian volunteers, continue their massive vaccination efforts in post-quake Haiti. And Raysoly´s estimate? That day in Place de Dame, the Cuban team vaccinated over 400 people. And the folks keep on coming: Esmeris just visited my tent to report that they broke a record in another camp where the teams are working. ¨We vaccinated over 500 people in Delmas 83 today. We worked from 9 to 2 and had to ask people to come back tomorrow.¨