GRF One Health Summit 2012, Davos: Presentation by Sidney Coupet, Doctors United for Haiti, USA

1. Sidney Coupet, DO, MPH
Robert Wood Johnson Foundation Clinical Scholar
Department of Internal Medicine
University of Michigan
Doctors United For Haiti (DUFH)
Founder and Executive Director
Haiti Cholera: The introduction of an inclusive implementation
model on Water Quality, Vaccination and Education.
A Comprehensive solution for Policymakers.

2. Topics for Discussion
Cholera in Proposed The Projected
Haiti Model impact
The steps to discovering a solution

3. Haiti’s Cholera Epidemic
Introduced to Haiti October, 2010 and is expected to remain.

4. -POOREST NATION IN THE WESTERN HEMISPHERE.
-40% OF THE POPULATION RELY STRICTLY ON TRADITIONAL
HEALERS.
-INADEQUATE SANITATION SYSTEMS AND NO RELIABLE SAFE
WATER SUPPLY IN MOST PARTS OF THE COUNTRY.
-ANY MAJOR STORM CAN PRODUCE SERIOUS FLOODING
AND SUBSEQUENTLY TRANSMIT RELATED INFECTIOUS
DISEASES AND WATER BORNE ILLNESSES.
-DIARRHEA AND INTESTINAL DISEASE DEATH RATE IS 31.97%
COMPARE TO US 7.35%.
Fertile Environment for Cholera

5. JANUARY, 12, 2010 HAITI’S DEVASTATING EARTHQUAKE
-LOST OF AT LEAST 300 HEALTH CARE PROVIDERS
-OVER 2 MILLION DISPLACED AND LIVING IN TENT CITIES IN
CLOSE QUARTERS
-MASSIVE DISTRUCTION OF HEALTHCARE RELATED
INFRASTUCTURES
(HOSPITALS/CLINICS/DISPENCERIES/MINISTRIES OFFICES)
-MASSIVE INFLUX OF INTERNATIONAL AID
A window of opportunity for Cholera

6. Cholera’s Impact /Interventions /Missed Opportunities
Over 300,000 infected and >5,000
deaths so far.
Current Interventions
CTC for acute care
Water chlorination
Dissemination of health
information through mass media
Despite the above interventions
Morbidity and Mortality are still rising.
Controversies surrounding the Cholera
Vaccination has delay its use in the
country.

7. Cholera Vaccination?
• Short stock pile of the vaccination
(Dukarol/Shanchol:200,000)
• Requires 2 doses or 1 dose
• 80% protective for 3 years
• Liquid and orally administered
• Requires 2-8 degrees Celsius
• General gaps
– Vaccination dissemination
– Limited stock pile
– Shortage of healthcare workforce
– Storage

8. The Proposed inclusive
Implementation Model.
Increases the reach of all Cholera Interventions

9. The Best Cholera Intervention is Comprehensive
Coupet/Nassiri Model: 9/2011

10. The Haiti Proposed Key Players Inclusive Implementation Model
for Cholera Intervention.
Water
Screening
for Cholera Vaccination
Key Players
Community Health workers
Haitian Healthcare Providers
Public health Officials
Traditional healers
Physician/nurse partners abroad
Education Acute Care
Integrated Inclusive Model: Coupet/Nassiri

11. The Proposed Model’s Logistical Approach
– Planning
• We will devise a course of action that will match using geographic locations to partner
health facilities with near by traditional healers. We will also provide the traditional
healers education at the sites.
– Engaging
• We will use volunteers who live in the communities and patients who were recently
affected by cholera to identify a traditional healer in the area. We will also use a snowball
effect to recruit other traditional healers.
– Executing
• We will have a highly trained public health official function as a liaison between the
health centers and the traditional healers.
– Reflecting and Evaluating
• We will measure the participation rate of traditional healers and willingness of Faith Base
Organizations (FBO) , Non-Governmental Organizations (NGOs) and Minister of Health
(MSPP) to work with traditional healers.
• We will evaluate the feasibility of traditional healers serving a role in educating, referring
patients and administering vaccine.
• Evaluating the outcomes of involvement of Healthcare Volunteers from abroad.
Realization of the Added Value of the Inclusive Model

12. The Projected Impact of
the Inclusive
Implementation Model.
Expanding The Reach of all Cholera Interventions

13. The Haiti Proposed Key Players Inclusive Implementation Model
for Cholera Intervention.
Water
Screening
for Cholera Vaccination
IMPACT
Reduced cholera
Key Players
Community Health workers morbidity and
Haitian Healthcare Providers mortality,
Public health Officials Healthier
Traditional healers populations,
Physician/nurse partners abroad Reduction in
workforce
Education Acute Care “downtime”
Model Suggested by: Coupet/Nassiri

14. Measured Impact of Key Players
Key Players Education Vaccination Water Acute Care
Screening for
Cholera
Community +++++ +++++ ++++ +
Workers in Haiti
Physician/Nurse +++++ +++++ +++ +++++
Providers in
Haiti
Public Health +++++ +++++ +++++ +
Officials
Traditional +++++ +++++ ++++ +++
Healers
Physician/Nurse +++++ +++++ ++ +++++
partners
abroad.
Opportunity for One Health Approach

15. Collaboration
-Everyone will be able to serve as an anchor
to expanding the reach of any cholera
intervention.
-Capitalizing on already established trust with
communities,
-Enhance the effectiveness of any proposed
comprehensive intervention for cholera
It’s about team work.

16. Our Integrated Academic Approach is in part a
step towards the introduction of One Health
Approach in Haiti.