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Cholera in the Caribbean


In Every rainy season, Cholera became the greatest public enemy in the Caribbean region. The problem begins when the floods contaminate drinking water from rivers and wells with the bacterium Vibrio cholerae. The epidemic hits the Eastern parts of the region with more than 200 confirmed cases and an average of 12 deaths each rainy season in Cuba only. These statistics combine with statistics from other Caribbean countries to confirm the devastating effect of Cholera thus making it a prime concern issue. The Cholera epidemic of Haiti in 2010 led to serious health and economic implications for the country that had also suffered a 7.0 magnitude earthquake the same year. The disease led to more than 470,000 reported cases and over 6,600 Cholera deaths in Haiti only according to Centre for Disease Control and Prevention in the U.S. (CDC). The issues of Cholera in the region require attention from all health stakeholders and researchers.

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Cholera in the Caribbean

Cholera is a severe infection in the small intestines caused by the bacterium Vibrio cholerae. The bacteria can be serogroup O139 or O1 and produce the toxin which causes cholera. The signs and symptoms range from vomiting and asymptomatic carriage to profound shock and diarrhea. 25% of cholera cases are fatal. The deaths may be up to less than or equal to 1%, but this is with medical intervention with aggressive electrolyte and volume replacement. There have been seven pandemic waves in the spread of the cholera since 1817. The longest substantial pandemic wave is the current one which started in 1961. The pandemic began in Indonesia and spread to Africa through Asia by 1971. It is caused by El Tor biotype of Vibrio cholerae o139 and O1. It spread to Latin America and the Caribbean in 1991 with more than 1 million confirmed cases and 9170 deaths in three years’ time. The classical biotype of the bacterium is quite rare (Honeyman, 2010).  

The transmission of Cholera is through contamination of food or water by infective feces. The disease is susceptible to a normal healthy adult after ingestion of about 100 million bacteria. Children from two to four years of age show the highest susceptibility, as well as adults with reduced gastric acidity and blood type O. The level of susceptibility also increases with reduced immunity such as people with AIDS or malnourished children. Any individual who suffers from cholera can develop a severe case with the loss of fluids. Some individuals are carriers of the V. cholerae bacteria without infection. These are individuals with cystic fibrosis, which is a genetic mutation. Cholera has various oral vaccinations such as Dukoral which has a success rate of between 53 and 63% with little or no side effects. Medical experts use oral rehydration therapy (ORT) and antibiotics such as Doxycycline, cotrimoxazole, furaxolidone, erythromycin and Fluoroquinolones for treatment of Cholera cases (Dubois, 2009).

Cholera transmission is low in industrialized countries due to availability of proper sewerage systems. In these countries, cholera spreads through shellfish or planktons which are carriers. To prevent a population from cholera, there should be sterilization and proper disposal of infected fecal waste. The relevant stakeholders should also conduct proper sewage disposal as well as water purification methods such as chlorination. The Caribbean region in general has had a history of poverty and poor health. The life expectancy at birth is 60 years and IMR estimations are at a high of 64 per 1000 live births. Approximately 87 children per 1000 births die below the age of 5 years. Maternal mortality rate is estimated at 630 per 100,000 live births, and less than 25% of the children who survive past 5 years experience stunted growth and malnutrition (average statistics from all countries). About 60% of the Caribbean population has access to healthcare due to shortage of professionals in healthcare and poverty. 70% have access to drinking water from pipes or wells, and around 30% have access to proper sanitation systems. This increases cholera prevalence in the Caribbean (Churchill, 2012).  

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According to medical journals, Cholera continues to be a health issue in the Caribbean especially in Hispaniola (Haiti and the Dominican Republic). Other islands such as Cuba, Jamaica, St Thomas, Puerto Rico, St Kitts, St Lucia, Trinidad, Nevis, St Vincent, the Bahamas, Anguilla, Granada, Tortola, St John, Caicos, the Turks, Antigua, Marie Galante, Martinique, Dominica, the Dominican Republic, Guadeloupe and Grenadines (Carriacou and Petite Martinique) have reported cholera cases since the 1800s up to 2013. The environmental detective works of John Snow have provided 2 centuries of research to show the prevalence of the disease in the Caribbean. The only exception is Haiti whereby Cholera severe cases were in 2010. The region has had three main epidemic waves, the second (1829-1851), the third (1852-2859) and the fourth (1833-1834). The fact that the Caribbean has diverse African ethnicities as well as Native Americans due to military force led to lack of institutional structure to handle these pandemics (Snow 1965).

Community health workers should come up with effective ways to deal with the current cholera outbreaks such as those in Haiti. CHNs should come up with a regional surveillance system to report spreading epidemics. This will allow them to position cholera prevention and treatment methods in the region such vaccination. The nurses should use this surveillance system to track where the spread of the outbreak starts to prevent further spread. This is possible by the use of phone records. Community Health Nurses should maintain cell phone records for all the people who leave the area for fear of infection from the Artibonite regions and educate them on prevention measures. CHNs should also advise epidemiologists to send text messages and give people a free number to call and report cholera cases. They should give directions to those who call on what to do if they get infected as well as methods of prevention. The CHNs should also liaise with NGOs, the government health providers and the international health experts from the UN such as the World Health Organization (WHO) to assist in prevention and treatment. A community health nurse Wiseline Celestine has initiated such a project in Haiti (Project Medishare) which has assisted in the management of cholera in Puerto Prince and its outskirts.

Community Health Nurses should also engage in methods to try and prevent the spread of the disease before a rainy season which often leads to cholera outbreaks in the region. These are laboratory studies and field investigations. These will let public health response teams to know the most effective interceptions in different regions as well as determine the areas with high prevalence and probability of infection. They should determine the water sources with risks of sewerage and fecal contamination and put signs indicating this. They should also train community health workers and clinical caregivers on cholera. This will ensure that there are enough personnel in the field to deal with an outbreak. CHNs should also work with health partners to increase capacity for treatment of cholera. They should use the expertise of organizations such as CDC, WHO and the Red Cross to plan on cholera management in the Caribbean region (Parkin & Bogue, 2012). CHNs should also work with local authorities in the region to manage and improve water, sanitation and hygiene. This is by setting up laws which support water treatment and sewerage management. The most crucial step in managing cholera in the Caribbean is educating the public. CHNs should come up with methods to educate the public on treating water, cooking food, washing hands, seeking healthcare and maintaining general hygiene.

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It is the role of a CHN to integrate the involvement of a community and provide information to the population with clinical and personal understanding of illnesses and health experiences of the families, as well as individuals within the Caribbean population. A CHN should articulate and translate illnesses and health experiences of families and individuals in the region to policy makers and health planners to assist community members voice their aspirations and problems. The nurse has knowledge about intervention strategies of those infected with cholera as well as prevention for the general population. A CHN should, therefore, use this knowledge of health and social science to assist stakeholders such as the government, WHO and other humanitarian groups such as the Red Cross to give interventions in the population, advocacy and programs to help in management of Cholera in the Caribbean. This way, the cholera pandemic in the Caribbean will be an issue of the past.

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