Wilson notes the concern on the ground about rises in diarrheal disease, especially in regards to children. He notes that it, "has already been documented that diarrheal disease is a major cause of morbidity and mortality both before the earthquake and after. We have observed apparent ‘bumps’ in diarrheal disease incidence following periods of sustained rainfall..."
Wilson encourages the relief community to underake a self evaluation:
Let us ask ourselves the difficult question of whether we are truly prepared if a substantial increase in diarrheal disease is observed across multiple locations? Specifically, although Promess has a large supply of Pedialyte, is it enough? What about oral and IV antibiotics? IV fluids and kits? How fast is this materiel able to be deployed throughout the IDP camps in response to reported outbreaks of diarrheal disease? Is the application mechanism agile enough to handle a high volume of requests, even though coming from unregistered groups? Have Haitian mothers been taught how to make oral rehydration salts (ORS) and how to use ORS solution proactively with their children?
Early Warning and Situational Awareness.
Formal public health surveillance currently consists of filling out forms and submitting them to the Haiti Ministry of Health once per week, with a developing network of sites to support laboratory testing. To augment this process, we would like to strongly encourage cluster members to not only fill out these forms but also engage in routine information sharing about events. This is referred to as “informal surveillance”, and we offer the following Google group, the “Haiti Epidemic Advisory System” and the InSTEDD-supported SMS/text messaging alert system called Geochat to facilitate communication among us. In this Google group we will be sharing insights into what to look for and examples of informal surveillance in action. Please note this group is only for ground-based Haiti responders. The link to the Google group may be found here, and instructions for how to sign up for the SMS/text messaging Geochat service is found on the group website: http://groups.google.com/group/haiti-epidemic-advisory-system?hl=en
If we are prepared and we are sharing warning information and situational awareness, are we then prepared as a community to respond? Response in this context may become quite challenging, particularly if the roads become more difficult to travel on due to rain and slides. Further, if we do not have adequate supplies coupled to agile logistical distribution, we will not be empowered as a responder community to respond. Imagine multiple sites say in Port-au-Prince that may or may not have on-site medical personnel who may or may not have enough supplies to respond to a crisis of diarrheal disease. We need to confront these questions as a community and make sure we are able to answer them before a crisis occurs.
We are here to facilitate this process and assist in a positive outcome for Haiti’s children. It is acknowledged this is a substantial and complex challenge, and we may see the deaths of children despite everything we attempt to prevent it. Here we encourage an exploration of all possible options proactively before the crisis is thrust upon us unprepared.