From Disaster Simulation to Reality: Trained Outreach Workers Respond to Haiti’s Cholera Outbreak

Although Haiti was officially declared cholera-free in February 2022, in September 2022, disaster training for staff at the Alyans Sante’ Borgne Hospital tested their cholera response plan . Just days later, an outbreak was reported in Port-au-Prince and by December 2022, this outbreak reached the remote northern communities around Borgne. With response training fresh in their minds, the hospital’s outreach team was ready to deploy rapidly and helped neighboring communities identify a site of contamination and seek treatment.

September 2022: Disaster Response Training Begins

In late September, facilitators from Haiti’s Alliance for Risk Management and Business Continuity (AGERCA) traveled to the town of Borgne in northern Haiti to deliver disaster response training to the hospital’s outreach team. The training was coordinated by Miyamoto International and Haiti Outreach Pwoje Espwa (H.O.P.E.), two partners participating in the U.S. Agency for International Development’s Diaspora Partnership Accelerator. H.O.P.E., a diaspora organization with 25 years of experience supporting health care in Borgne, intended to add to hospital outreach workers’ tools and ability to quickly assess community emergencies and identify those most in need of care. When the training started in September, cholera prevention was just part of a larger hypothetical simulation training that also included earthquake and tsunami response. At that time, Haiti had been declared cholera free after officially passing the three-year mark without a confirmed case. But just a few days after the first training session, all that changed.

October 2022: An old epidemic returns

In early October, there were two cholera cases reported in the capital of Port au Prince, but by the end of the year, the Haitian Ministry of Public Health and Population confirmed at least 13,276 cases nationwide.

Only one road leads to the remote town of Borgne, where the hospital serves a community of over80,000 people. Some patients travel as many as nine hours on foot to reach the hospital for care, but there are thousands more in the surrounding villages who cannot make that journey. Instead, the trained outreach workers trek the mountainous terrain on foot or by donkey to reach towns inaccessible by road. Due to their decentralized approach and close community ties—a strategic public health model developed by H.O.P.E. called Sante Nan Lakou—this team was in the best position to rapidly respond to the cholera outbreak when it reached the remote neighboring towns.

December 2022: Putting new knowledge to the test to stop an outbreak

By December 2022, the outreach team began to incorporate new knowledge from AGERCA’s second disaster training session into their door-to-door visits. While previous outreach workers had firsthand experience with cholera, the training exercises allowed this younger team to pair their knowledge of water quality with new skills in rapid community needs assessments, triage and hygiene outreach.

“The training got them really thinking about preparation and how to get people to a treatment center. It was a good practice run for an outreach team that hadn’t been tested in that way,” said Jim Myers, H.O.P.E. Board Member and lead for the Diaspora Accelerator project.

As a result, the team not only educated community members, they also identified a source of contamination in the commune of Malvas where a natural spring was not properly protected. The team then worked with the community to ensure that drinking water from the natural spring was treated with Aquatabs or boiled before consumption. “In Borgne, this project prepared us to face the new outbreak of cholera. The results are really impressive and the change is positively significant,” said Dr. Thony Voltaire, Medical Director at the hospital.

May 2023 – Disaster simulation exercises bring knowledge to life

In May 2023, the same team participated in their third progressive disaster training. The team ran through high-stress hypothetical scenarios where influxes of patients flooded the hospital following road accidents, earthquakes, or tsunamis. Hospital staff ran live drills and practiced how they would treat patients while assessing the highest community needs and triaging the injuries coming in.

The Diaspora: A key resource in disaster response

Disaster risk reduction trainings like these provide realistic and unforgettable examples for first responders. Due to Haiti’s high vulnerability to disease and disasters, the outreach team will likely have to put their skills to the test again in the future. Thanks to their knowledge and unique ability to reach people in need, H.O.P.E.’s outreach team is invaluable to the people of Borgne. Through these disaster risk reduction trainings, the team has not only learned to respond to an outbreak but also gained the tools to assess impacts, determine the highest needs, and decide how to coordinate a response with severely limited resources regardless of the type of disaster.

The Diaspora: A key humanitarian resource .

The hospital’s alliance with the diaspora organization, H.O.P.E, has had an incredible impact on disease prevention and access to care. The Diaspora Partnership Accelerator is an innovative funding model at USAID that finances diaspora organizations as humanitarian partners due to their deep connections with communities in Haiti. In addition to funding training sessions, funding from the Accelerator has also supported H.O.P.E and the Alyans Sante’ Borgne Hospital with mobile health clinics, disease screenings, pregnancy groups and additional nurse salaries.

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