Special report: Is aid doing Haiti more harm than good?

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By Simon Denyer

PORT-AU-PRINCE | Mon Oct 25, 2010 7:23pm EDT

(Reuters) - It was Haiti's premier private hospital, its rooms filled with the latest medical equipment, its surgeons trained in the latest techniques, its thick walls built to withstand an earthquake.

Those walls stood firm when the earth shook on January 12, and for three months after that devastating quake the CDTI du Sacre Coeur Hospital threw open its doors, treating thousands of victims free of charge.

American and French doctors, flown in by their respective governments, worked non-stop in CDTI's operating rooms together with their Haitian counterparts seeing more than 12,000 patients and performing more than 700 major surgeries.

Today, the hospital stands empty, its consulting and operating rooms abandoned, its beds unused, its scanners gathering dust, its two brand new ambulances sitting under tarpaulins in the yard. On April 1, owner Reynold Savain was forced to close CDTI because neither the Haitian nor U.S. governments, nor the United Nations, would agree to help pay his bills.

The echoing corridors of the hospital are a monument to the failure of the Haitian government and the international community to work with the private sector to rebuild. The risk is that billions of dollars of aid will once again fail to leave any lasting legacies in the Western Hemisphere's poorest country.

A cholera outbreak in recent days only underlines the vulnerabilities of Haiti's dysfunctional systems.

Savain said when he asked the World Health Organization to help cover his doctors' salaries, they offered to pay in food and blankets, of no use to professionals who needed cash to pay rent and school fees.

"Philosophically, they can't work with the private sector, that is the real issue," the white-haired Savain said as he opened door after door to empty rooms.

"They want to put everything through the public sector, but they have to find a way to strengthen the private sector."

Friends say Savain made mistakes too in handling the issue, sending invoices to the U.S. Agency for International Development (USAID), as though he had a right to charge every patient his full private rates at a time of national emergency, instead of looking for a compromise.

Nonetheless, nine months after the earthquake struck, there is a strong sense that the Haitian government, foreign donors and non-governmental organizations (NGOs) and the domestic private sector are simply not pulling in the same direction, not even talking the same language.

HEALTH SYSTEM VULNERABLE

Time after time, Haiti has endured disaster followed by aid that did little to build long-term prosperity -- bypassing both the government and the private sector. From corrupt politicians to nepotistic elites and well-meaning outsiders who thought they knew best, there is plenty of blame to go around.

The question is how to break the cycle and rebuild after the quake which killed at least a quarter of a million people and rendered more than a million homeless, leaving vast swathes of Port-au-Prince in ruins.

The disaster drew an outpouring of sympathy from around the world and foreign aid has had significant successes. But it is not providing, and seems unable to provide, permanent private sector jobs. This is nowhere more apparent than in agriculture and in private healthcare

WFP Buys Over 3,000 Metric Tonnes of Food From Farmers

Kigali — The United Nations WFP announced on Tuesday that it had purchased food worth Rwf352.8 million (US$600,000) through its Purchase for Progress (P4P) initiative which has benefitted hundreds of families in the country.

P4P programme was launched in 2008 by President Paul Kagame with an aim of empowering small scale farmers from developing countries, through buying foodstuffs from them to supply areas where WFP has operations.

A total of 3,300 metric tonnes of maize grain and beans was bought in the Eastern and Southern provinces from 37 cooperatives and two farmers' unions, bringing together more than 14,000 small scale farmers.

Bernadette Furaha, a mother of four, started cultivating a small plot of land in Kirehe District, Eastern Province, after her husband was killed in the1994 Genocide against the Tutsis.

She said that through P4P, she was trained by WFP on post-harvest management and managed to sell her maize to WFP.

"My life has changed drastically," said Furaha, who used the proceeds to build an iron-roofed house worth Rwf200,000, bought a cow and paid her children's school fees.

FOR MORE ABOUT THIS STORY CLICK HERE TO READ IT @ ALL AFRICA.COM

WFP to Buy U.S.$100 Million Food

http://allafrica.com/

Paul Busharizi

14 October 2009

interview

Kampala — IN the run up to the World Food Day tomorrow, October 16, Paul Busharizi, spoke to the the World Food Programme (WFP) country director, Stanlake Samkange, about Purchase for Progress, a new WFP initiative poised to make Ugandan small-holder farmers major players in the regional quality grain market.

Outline what the Purchase for Progress programme is all about. When was it initiated and what prompted its creation?

The Purchase for Progress, or P4P, is a five-year pilot project that WFP launched last year in partnership with the Bill and Melinda Gates Foundation.

It aims at working with governments in 21 developing countries, including Uganda, to expand market opportunities for small-holder farmer groups.

In recent years, WFP has realised that increased cash contributions from donors have made it possible for it to become a stable and substantial purchaser of food in developing countries.

About two years ago, WFP started to explore ways in which these purchases could promote development of small-scale agriculture. That was the origin of P4P.

The project in Uganda features two main aspects; developing market infrastructure, both physical and informational, and enhancing productivity. Plans have been developed in collaboration with the Ministry of Agriculture, Animal Industry and Fisheries.

Regarding enhanced productivity, WFP will complement the work of the Food and Agriculture Organization (FAO) by assuring demand, supporting improved post-harvest handling and encouraging value addition.

What does WFP hope to achieve with this initiative?

WFP foresees P4P as a major catalyst of increased agricultural production, which will result in the gainful participation of small-holder farmers in the market. The initiative should open up the regional quality food market for Uganda's small-holder farmers.

Under the project and other purchase mechanisms, WFP would like to double the amount of food it has been buying in Uganda in recent years to make about $100m worth of purchases annually, in the next five years. This should help farmers improve their quality of life through increased incomes.

P4P is one of WFP's longer-term solutions to global hunger. In Uganda, it has been positioned to support the Poverty Eradication Action Plan, the Plan for Modernisation of Agriculture and the anticipated National Development Plan.

What is the progress so far in rolling out this project in Uganda?

P4P was launched globally about a year ago. Through the warehouse receipt system, we have bought close to 1,000 tonnes of maize from farmer groups in the Jinja and Masindi. We would like to buy about 3,000 by the end of the year.

In collaboration with SG 2000 and the Uganda Commodity Exchange (UCE), we have sensitised over 3,400 farmer group leaders in post-harvest handling and agricultural financing.

In the next few weeks, we will begin to construct a 2,000-tonne regional warehouse, which will be equipped with a cleaning and drying plant. We recently opened an office in Iganga and will soon open one in Hoima. The new offices will help us take demand closer to producers.

Busoga produces substantial amounts of maize, but it is of poor quality, largely due to the use of poor post-harvest methods. Now we can work closely with the farmer groups to help them improve their quality.

Mostly, we have been buying maize and beans through competitive bidding. However, last December, WFP signed an agreement with the commodity exchange and began direct purchases through the warehouse receipt system. In the next few weeks, we would like to start making forward contracts with farmers.

We want to buy maize and beans, as well as other staples including, sorghum, millet and fish. With alternative staples, we can buy more food and offer a bigger market.â-àWe will at the same time be able to address micro-nutrient deficiencies in crisis areas such as Karamoja

What is Uganda's potential as a regional or international supplier for the WFP?

There are times when WFP has been forced to buy food from South Africa, ship it to Mombasa, transport it across Uganda to the DR Congo. That is because there is not enough quality grain or beans in the region.

With improved supply, quality and market guarantees from WFP and other P4P innovations, Uganda can produce enough maize for the region. WFP can absorb everything that Uganda can produce, but we cannot buy it all because then it would upset the market. Under P4P, WFP is looking to work with the FAO and the national agricultural advisory services to increase production. FAO supports farmer field schools, where farmers come together to learn about productive agriculture.

WFP will assist farmer field schools, mostly in northern Uganda, by supporting market linkages and providing a market.

Are you exporting any of the food?

About 20% of the food that WFP buys in Uganda is exported to Rwanda, Burundi and DRC. The remaining 80% is used to support operations in Uganda.

In the coming months, however, we expect a reduction in relief needs in Uganda and see WFP take a lead in supporting regional operations through local purchases in Uganda.

What have been the major challenges in rolling out the project in Uganda? Sensitisation, poor agricultural practices, or the economic environment?

The main problems that farmer groups face are the lack of cleaning and drying equipment and adequate modern storage facilities. Farmers are often forced to dry their maize on the ground at the mercy of unreliable weather, which compromises quality. And then, they are forced to rely on stores that can only take about five tonnes.

Some farmers that have signed contracts to supply food to WFP are sometimes forced to sell their food since they are unable to meet the quality and quantity specifications required by WFP. WFP has made orders for cleaning and drying equipment. We will supply it in areas where we have collaborations with UCE and where we will set up market collection points. Kapchorwa, Kasese, Masindi, Gulu and Iganga districts will be some of the first beneficiaries.

What are the possibilities for value addition under this programme and what form could this (value addition) take?

P4P will support grain milling for easier cooking, fortification with micro-nutrients, bagging to prevent tampering, and drying, salting and smoking of fish to increase its shelf-life. Also, P4P intends to support processing, working with farmer associations and the private sector.

How does P4P relate to this year's theme for the World Food Day: "Achieving food security in times of crisis"?

Recently, the media has been reporting on the impacts of the global economic crisis. We need to realise that not everybody, who has been affected, works for a big bank, a big insurer or a major car company.

The FAO has said the global crisis is stalking small-scale farmers of the world, in part because of dwindling amounts of money sent home from relatives working abroad and last year's high fuel and food prices. P4P should help make small-scale farmer groups beneficiaries, not victims of the crisis.

The approach that WFP uses in strengthening regional trade for Uganda, is not to establish itself as the sole buyer, but rather as one of the buyers.

Cholera

KEY FACTS

Cholera is an acute diarrhoeal disease that can kill within hours if left untreated.
There are an estimated 3–5 million cholera cases and 100 000–120 000 deaths due to cholera every year.
Up to 80% of cases can be successfully treated with oral rehydration salts.
Effective control measures rely on prevention, preparedness and response.
Provision of safe water and sanitation is critical in reducing the impact of cholera and other waterborne diseases.
Oral cholera vaccines are considered an additional means to control cholera, but should not replace conventional control measures.

Cholera is an acute diarrhoeal infection caused by ingestion of food or water contaminated with the bacterium Vibrio cholerae. Every year, there are an estimated 3–5 million cholera cases and 100 000–120 000 deaths due to cholera. The short incubation period of two hours to five days, enhances the potentially explosive pattern of outbreaks.

Symptoms

Cholera is an extremely virulent disease. It affects both children and adults and can kill within hours.

About 75% of people infected with V. cholerae do not develop any symptoms, although the bacteria are present in their faeces for 7–14 days after infection and are shed back into the environment, potentially infecting other people.

Among people who develop symptoms, 80% have mild or moderate symptoms, while around 20% develop acute watery diarrhoea with severe dehydration. This can lead to death if untreated.

People with low immunity – such as malnourished children or people living with HIV – are at a greater risk of death if infected.

History

During the 19th century, cholera spread across the world from its original reservoir in the Ganges delta in India. Six subsequent pandemics killed millions of people across all continents. The current (seventh) pandemic started in South Asia in 1961, and reached Africa in 1971 and the Americas in 1991. Cholera is now endemic in many countries.

Vibrio cholerae strains

Two serogroups of V. cholerae – O1 and O139 – cause outbreaks. V. cholerae O1 causes the majority of outbreaks, while O139 – first identified in Bangladesh in 1992 – is confined to South-East Asia.

Non-O1 and non-O139 V. cholerae can cause mild diarrhoea but do not generate epidemics.

Recently, new variant strains have been detected in several parts of Asia and Africa. Observations suggest that these strains cause more severe cholera with higher case fatality rates. Careful epidemiological monitoring of circulating strains is recommended.

The main reservoirs of V. cholerae are people and aquatic sources such as brackish water and estuaries, often associated with algal blooms. Recent studies indicate that global warming creates a favourable environment for the bacteria.

Risk factors and disease burden

Cholera transmission is closely linked to inadequate environmental management. Typical at-risk areas include peri-urban slums, where basic infrastructure is not available, as well as camps for internally displaced people or refugees, where minimum requirements of clean water and sanitation are not met.

The consequences of a disaster – such as disruption of water and sanitation systems, or the displacement of populations to inadequate and overcrowded camps – can increase the risk of cholera transmission should the bacteria be present or introduced. Epidemics have never arisen from dead bodies.

Cholera remains a global threat to public health and a key indicator of lack of social development. Recently, the re-emergence of cholera has been noted in parallel with the ever-increasing size of vulnerable populations living in unsanitary conditions.

The number of cholera cases reported to WHO continues to rise. From 2004 to 2008, cases increased by 24% compared with the period from 2000 to 2004. For 2008 alone, a total of 190 130 cases were notified from 56 countries, including 5143 deaths. Many more cases were unaccounted for due to limitations in surveillance systems and fear of trade and travel sanctions. The true burden of the disease is estimated to be 3–5 million cases and 100 000–120 000 deaths annually.

Prevention and control

A multidisciplinary approach based on prevention, preparedness and response, along with an efficient surveillance system, is key for mitigating cholera outbreaks, controlling cholera in endemic areas and reducing deaths.

Treatment

Cholera is an easily treatable disease. Up to 80% of people can be treated successfully through prompt administration of oral rehydration salts (WHO/UNICEF ORS standard sachet). Very severely dehydrated patients require administration of intravenous fluids. Such patients also require appropriate antibiotics to diminish the duration of diarrhoea, reduce the volume of rehydration fluids needed, and shorten the duration of V. cholerae excretion. Mass administration of antibiotics is not recommended, as it has no effect on the spread of cholera and contributes to increasing antimicrobial resistance.

In order to ensure timely access to treatment, cholera treatment centres (CTCs) should be set up among the affected populations. With proper treatment, the case fatality rate should remain below 1%.

Outbreak response

Once an outbreak is detected, the usual intervention strategy is to reduce deaths by ensuring prompt access to treatment, and to control the spread of the disease by providing safe water, proper sanitation and health education for improved hygiene and safe food handling practices by the community. The provision of safe water and sanitation is a formidable challenge but remains the critical factor in reducing the impact of cholera.

Oral cholera vaccines

There are two types of safe and effective oral cholera vaccines currently available on the market. Both are whole-cell killed vaccines, one with a recombinant B-sub unit, the other without. Both have sustained protection of over 50% lasting for two years in endemic settings.

One vaccine (Dukoral) is WHO prequalified and licensed in over 60 countries. Dukoral has been shown to provide short-term protection of 85–90% against V. cholerae O1 among all age groups at 4–6 months following immunization.

The other vaccine (Shanchol) is pending WHO prequalification and provides longer-term protection against V. cholerae O1 and O139 in children under five years of age.

Both vaccines are administered in two doses given between seven days and six weeks apart. The vaccine with the B-subunit (Dukoral) is given in 150 ml of safe water.

WHO recommends that immunization with currently available cholera vaccines be used in conjunction with the usually recommended control measures in areas where cholera is endemic as well as in areas at risk of outbreaks. Vaccines provide a short term effect while longer term activities like improving water and sanitation are put in place.

When used, vaccination should target vulnerable populations living in high risk areas and should not disrupt the provision of other interventions to control or prevent cholera epidemics. The WHO 3-step decision making tool aims at guiding health authorities in deciding whether to use cholera vaccines in complex emergency settings.

The use of the parenteral cholera vaccine has never been recommended by WHO due to its low protective efficacy and the high occurrence of severe adverse reactions.

Travel and trade

Today, no country requires proof of cholera vaccination as a condition for entry. Past experience shows that quarantine measures and embargoes on the movement of people and goods are unnecessary. Isolated cases of cholera related to imported food have been associated with food in the possession of individual travellers. Consequently, import restrictions on food produced under good manufacturing practices, based on the sole fact that cholera is epidemic or endemic in a country, are not justified.

Countries neighbouring cholera-affected areas are encouraged to strengthen disease surveillance and national preparedness to rapidly detect and respond to outbreaks should cholera spread across borders. Further, information should be provided to travellers and the community on the potential risks and symptoms of cholera, together with precautions to avoid cholera, and when and where to report cases.

WHO response

Through the WHO Global Task Force on Cholera Control, WHO works to:

provide technical advice and support for cholera control and prevention at country level
train health professionals at national, regional and international levels in prevention, preparedness and response of diarrhoeal disease outbreaks
disseminate information and guidelines on cholera and other epidemic-prone enteric diseases to health professionals and the general public.

Cholera Outbreak in Haiti

EOC SITUATION REPORT #2 Cholera Outbreak in Haiti
Summary
• As of today, the MSPP (Ministère de la santé publique et de la population) has reported 2,564 cases and 194 deaths at the national level.
• MSPP’s national reference laboratory today confirmed cases in Ouest Department, including Port-au-Prince. In addition to Central Department and Artibonite Department which had confirmed cholera cases since Friday.
• Suspected cases have also been detected in Nord Department and Sud Department and results of confirmatory tests are pending.
• While no cases of cholera have been reported in Dominican Republican, the outbreak has prompted the Government to mobilize a contingency plan in the border area, while the border remains open.
PAHO/WHO Response
• PAHO continues the mobilization of experts in various fields including epidemiologists, risk communication, case management, laboratory, water and sanitation, logistics, and LSS/SUMA experts to both Haiti and Dominican Republican to provide technical support to MSPP and to strengthen the PAHO offices.
• PAHO currently has medicines and supplies to cover initial treatment needs in stock at the PROMESS warehouse near the Port-au-Prince airport. Additional supplies have been estimated based on new information and are in the process of being procured.
• The PAHO/WHO website has been populated with multilingual guidelines to provide general guideline during a cholera outbreak. The following documents readily available in PAHO’s website: Acute diarrhoeal diseases in complex emergencies: critical steps; First steps for managing an outbreak of acute diarrhea; Cholera fact sheet; Cholera outbreak: assessing the outbreak response and improving preparedness; and, Cholera: prevention and control. Other relevant documents are listed in the Resources section below.
• PAHO remains in close collaboration with health cluster partners, including the Cuban medical mission, MSF, MINUSTAH, OCHA, USAID, USCDC, UNICEF and other governmental and non-governmental organizations to respond to the outbreak. PAHO is also coordinating closely with health officials in the U.S. and Canada, including with HHS, the
Emergency Operations Center (EOC) – PAHO
Page 1
Saturday, October 23, 2010 6:00 PM, EDT
Cholera Outbreak in Haiti Pan American Health Organization
State Department, the CDC, NIH, and the FDA, and in Canada, with Health Canada, PHAC, and CIDA.
Cholera Key Facts
• Cholera is an acute diarrheal infection caused by exposition, ingestion of food or water contaminated with the bacterium Vibrio cholerae 0:1.
• Provision of safe water and sanitation is critical in reducing the impact of cholera and other waterborne diseases.
• Up to 80% of cases can be successfully treated with oral rehydration salts. • There are an estimated 3–5 million cholera cases and 100 000–120 000 deaths due to
cholera every year around the world.

PAHO Responds to Cholera Outbreak in Haiti

Washington, Oct. 21, 2010 – The Pan American Health Organization said today that it has received laboratory confirmation of cases of cholera in Haiti, in Artibonite province, and is responding to help the Ministry of Health assess the situation and respond appropriately to save lives. So far, PAHO has been informed that more than 1,500 cases of severe diarrhea and at least 138 deaths have been reported in St. Marc, Grande Saline, and Mirebalais.

PAHO has mobilized epidemiologists and other experts from its office in Port-au-Prince and from other countries to help local and national authorities assess and deal with the event, which marks the first time cholera has appeared on the island of Hispaniola, shared by Haiti and the Dominican Republic.

The organization is collaborating with partners including the US Centers for Disease Control, US Agency for International Development, OCHA, Medecins Sans Frontieres, and other non-government organizations to combat the outbreak.

Cholera is an disease caused by ingestion of food or water contaminated with the bacterium Vibrio cholerae. An acute intestinal infection, it causes severe watery diarrhea and vomiting, and can quickly lead to severe dehydration and death. Most cases can be treated with oral rehydration salts, though more severe cases need hospitalization with intravenous fluids and appropriate antibiotics. The goal of treatment is to keep up with fluid loss caused by diarrhea and vomiting.

“With good case management, we can prevent people from dying, perhaps only <1%>

“The challenge for Haiti will be to ensure all severe infections are adequately cared for. One of the benefits of the response to the earthquake is that most people feel that citizens have better access to health services. This access will need to be further enhanced in the initial phases of this outbreak. It is likely that outbreak will continue to spread, but with adequate provision of services, mortality can be maintained at very low levels. Community mobilization and education on washing hands and safe water will be critical to stopping transmission. The strong partnership that exists should go a long way toward achieving that end,” Dr. Andrus said.

On January 12, 2010, a powerful 7.0 earthquake devastated Haiti, causing massive loss of life, catastrophic building damage, and unimaginable human suffering. The Government of Haiti estimates 220,000 people lost their lives and over 300,000 people were injured. The earthquake crippled Haiti’s infrastructure, and eight hospitals were destroyed and 22 seriously damaged in the three regions most affected. In the weeks and months after the earthquake, more than 1.5 million internally displaced Haitians settled in temporary sites throughout Port-au-Prince and beyond. Health Cluster partners collaborated on projects addressing acute health needs and pervasive threats associated with crowded and unhygienic living conditions. The Centers for Disease Control, the Ministry of Health, and PAHO/WHO established a system of disease surveillance using fixed health facilities and mobile clinics, which helped pick up these cases.

Cholera transmission is closely linked to inadequate environmental management. Typical at-risk areas include urban slums, where basic infrastructure is not available, as well as camps for internally displaced people or refugees, where minimum requirements of clean water and sanitation are lacking.

The consequences of a disaster such as the Haiti earthquake, including disruption of water and sanitation systems, or the displacement of populations to inadequate and overcrowded camps – can increase the risk of cholera transmission should the bacteria be present or introduced. Epidemics have never arisen from dead bodies.

Worldwide, there are an estimated 3–5 million cases and 100,000–120,000 deaths due to cholera every year. Provision of safe water and sanitation is critical in reducing the impact of cholera and other waterborne diseases.

During the 19th century, cholera spread across the world from its original reservoir in the Ganges delta in India. Six subsequent pandemics killed millions of people across all continents. The current (seventh) pandemic started in South Asia in 1961, and reached the Americas in 1991, spreading rapidly from Peru to 20 other countries. At its peak in 1991, the pandemic in the Americas affected some 396,000 people. In 1992 358,000 cases were reported, in 1993 it dropped to 211,000, and cases began to decline as a result of strong public health awareness and hygiene measures. Cases have not been widely reported in the Americas since 2001.

Cholera remains a global threat and is one of the key indicators of social development. While the disease no longer poses a threat to countries with minimum standards of hygiene, it remains a challenge to countries where access to safe drinking water and adequate sanitation cannot be guaranteed. Almost every developing country faces cholera outbreaks or the threat of a cholera epidemic.

Press briefing by PAHO Deputy Director Jon Andrus on the cholera outbreak in Haiti

Washington, DC, Oct. 22, 2010 – Good afternoon, thank you for taking the time to come to this press briefing on Haiti.

An outbreak of cholera in the Artibonite region of Haiti has resulted in more than 1,500 cases and 138 deaths since Tuesday, according to reports received by the Pan American Health Organization or PAHO. These are preliminary figures and we expect them to change.

Specimens from hospitalized patients were rapid-tested by Haiti's national laboratory in Port au Prince and were subsequently confirmed to be actually cholera in this lab, which is supported by CDC.

The reported cases and deaths have come primarily from areas where there was no direct damage from the earthquake, but where there are vulnerable populations living in impoverished situations.

We do not know yet if cases are occurring in the temporary settlements housing people who were displaced by the January 12th earthquake. We are diligently looking for any additional cases, particularly in these vulnerable communities.

Cholera is transmitted through fecal contamination of water and food. In places where there is infrastructure damage, the lack of safe drinking water and poor sanitation and hygiene can increase the risk of cholera, as well as numerous other diarrheal diseases.

Fortunately, cholera is easily treatable, and if patients are given oral rehydration salts promptly to replace lost fluids, they can nearly always be cured.

In a small percentage of people, cholera can cause very severe dehydration potentially leading to death. In these cases, intravenous administration of fluids is needed to save the person's life.

Outbreaks can be mitigated and deaths can be reduced through several measures that are effective with community participation. Human practices in personal hygiene and food preservation have a major impact on the occurrence and severity of outbreaks.

So really the bottom line in response to this current situation, is to minimize the number of people infected through mitigating measures such as frequent hand washing, personal hygiene, safe water use and food preparation, while at the same time minimizing the number of deaths through effective case management that prevents severe dehydration.

Cholera is considered an immediate health risk after disasters only when it is already present in the affected area. No cases of cholera had been reported in Haiti for some time, so we were not expecting to see the disease based on previous experience.

Surveillance was, however, monitoring for clusters of acute diarrhea, and up to now we had not seen clusters of acute diarrhea of this size.

The preliminary case fatality rate is over 9 percent, but this is likely to change.

PAHO/WHO Action:

In support of the local and national response, PAHO has mobilized epidemiologists and other experts from its office in Port au Prince and from other countries to help investigate and manage the outbreak. This includes experts with experience in cholera.

PAHO is also ready to provide the needed supplies identified by the Ministry of Health.

PAHO currently has medicines and supplies in stock at the PROMESS warehouse near the Port-au-Prince airport including 750,000 packets of oral rehydration salts-enough to treat 100,000 cases of moderate diarrhea-and enough intravenous (IV) fluids to treat 4,000 cases of severe diarrhea. PROMESS also has 300,000 courses of antibiotics. Haiti will need more supplies as cases continue to emerge. PAHO is working very hard to ensure sufficient supplies will be made available as we see more cases.

PAHO is collaborating with health cluster partners, including the Cuban medical mission, MSF, Minustha, OCHA, USAID, USCDC, UNICEF and other governmental and non governmental organizations to respond to the outbreak.

PAHO is also coordinating closely with health officials in the U.S. and Canada, including with HHS, the State Department, the CDC, NIH, the FDA, and USAID and in Canada, with Health Canada, PHAC, and CIDA.

I will stop there and answer any questions that you may have.

thousand die of cholera in Haiti - while WFP staffers leave the good life in private boats

millions of dollars of donations instead of going to eradicate extreme poverty in Haiti - has been diverted thanks to WFP/MINUSTAH to luxury boats and private residences where International Staffers enjoy the good life, dance and drink cold beers.

While Haitians die everyday of extreme poverty and misery - the United Nations Staffers receive the following:

- Daily Hardship: $ 189.00

- Rest & Recuperation travels : - every 3 weeks to Florida or Bahamas or Dominican Rep;

- Salaries: Net + H hardship level;

On top of the above United Nations and WFP/MINUSTAH spend close to 3 Million Dollars on administrative and operational expenses - every month to provide luxury accommodation and access to top health care facilities for all 9000 or so International Staffers.

So where are the poor Haitians? They are only good for Donor Conferences, where millions of dollars are trusted to the United Nations to "improve the life of Haitians". After the conferences are done, and the money is in Swissbank accounts of United Nations, no one cares any-longer about the Haitians. From January until October 2010 in less than 10 months the United Nations have made a profit close to 40 million USD form the donations that are sleeping in the UN's Bank Accounts in Switzerland.

Thank you Haiti !

New Global Alliance Embraces Clean Cooking Stoves

Source: United Nations World Food Programme (WFP)

Date: 21 Sep 2010

WFP is at the forefront of a new alliance to bring fuel-efficient cooking stoves to millions of poor families. Formed under the auspices of the Clinton Global Initiative, the alliance is setting out to use clean stoves to help to preserve the environment and protect women from violence.

ROME – A global alliance to promote the use of energy efficient cooking stoves across the developing world was announced Tuesday at the Clinton Global Initiative annual meeting in New York.

The Global Alliance for Clean Cookstoves, led by the United Nations Foundation and with WFP as a key partner, aims to provide 100 million households with access to clean and safe household cooking solutions by 2020. This will, in turn, save lives, improve livelihoods, reduce climate change emissions, and help meet a host of MDGs.

"WFP is deploying thousands of these stoves to help women cook food with a fraction of the wood they would normally use," explained WFP Executive Director Josette Sheeran. "That helps to save lives, protect women and protect the environment."

Many players

The alliance includes players the private sector, non-profit organisations, foundations, universities, companies, governments and other UN agencies.

It will build on the experience of previous projects, as there are many country-specific initiatives around cooking stoves, as well as drawing upon new technology developments to find a large-scale solution for the problems caused by inefficient stoves across the developing world.

In additions to its strong field presence and long experience working in remote hard-to-reach locations, WFP's Safe Access to Firewood and Alternative Energy (SAFE) programme puts it at the forefront of efforts to address household energy issues.

SAFE Stoves

In many parts of the world, most of the cooking is done indoors over an open fire, which gives rise to a number of health and safety risks that more efficient ways of cooking can help reduce.

Deforestation is perhaps the most visible, releasing greenhouse gasses and exposing people to floods, soil erosion and desertification that exacerbate poverty and hunger. The stoves provided through the SAFE programme can cut down a family's fuel needs by up to 50 percent, greatly reducing their impact on the environment.

They also produce less smoke, an important benefit for the millions of people who suffer from lung infections and pneumonia as a result of cooking inside poorly ventilated homes. According to the World Health Organization, "indoor air pollution" kills an average of 1.6 million people every year—about 40 percent more than malaria.

Just as importantly, efficient stoves reduce the amount of time women and children spend gathering firewood in conflict-ridden countries like Uganda, where they risk violence and rape at the hand of roving bandits. In post-conflict countries like Sri Lanka as well, efficient stoves can help reduce the likelihood of stepping on a landmine or unexploded bomb.

New Stoves to Improve Livelihoods and Save Lives

The WFP SAFE programme provides a variety of stoves, from the industrial steel stoves for preparing many school meals to the small clay stoves for cooking daily meals. (WFP/Rein Skullerud)

For millions of families living in poverty worldwide, having an efficient stove can be a matter of live and death.

A good stove can make humble meals that nourish the whole family, inefficient stoves, however, waste fuel and increase their burdens.

In some countries, women face significant danger when gathering cooking fuel. In Uganda women are raped by roving bandits, and in Sri Lanka they are injured by land mines when they go deep into the woods to find firewood, according to a press release by the World Food Program (WFP).

The WFP and the United Nations have launched a global initiative to promote the use of energy-efficient stoves in developing countries.

WFP’s executive director, Josette Sheeren, said at a U.N. conference in New York, on Sept. 21, that the efficient stoves use up to a quarter less fuel, improving the lives of many young girls who have to walk miles, carrying heavy loads of firewood on their backs.

The campaign aims to provide 100 million households around the globe with more efficient stoves by 2020. In addition to improving quality of life for poor families, the stoves will also reduce carbon dioxide emissions, according to WFP.

Traditional stoves in many countries are often open and located inside homes causing unsafe "indoor air pollution.” This pollution kills an average of 1.6 million people every year, according to the World Health Organization.

Other concerns related to the issue of inefficient stoves are deforestation and soil erosion. While deforestation contributes to the carbon dioxide emissions, soil erosion aggravates the effects of floods.

Free rice game gets social boost

BBC NEWS (CLICK HERE)

An online game reminiscent of quiz show Call My Bluff is getting a facelift in order to provide rice to the hungry.

Launched in 2007, Freerice.com challenges people to find the correct meaning of a word from four alternatives.

For every correct answer given, 10 grains of rice are donated to countries such as Uganda and Bangladesh.

Already attracting 40,000 players every day, the site is now aiming to integrate with Facebook and Twitter.

A mobile phone app will also be available for iPhone and iPad users, and the site is extending its challenges so that users can also test their knowledge of other subjects, such as art, geography, chemistry and maths.

The site is the brainchild of computer programmer John Breen, who originally designed it to help his teenage sons prepare for their college entrance exams.

Realising the game's potential to help, he donated it to the World Food Programme (WFP).

Within a month of its launch, it had raised enough rice to feed over 50,000 people for a day. To date it has raised enough rice to feed more than four million people for a day.

The rice is provided by the WFP and paid for by advertisers.

Every time a person gets a correct answer the advertisement running at the bottom of the site changes and the advertiser pays for ten grains of rice.

Integrating the site with Facebook and Twitter is something hardcore players have been requesting for a long time, said Nancy Roman, director of communication for the World Food Programme.

"Freerice is making internet history," said Ms Roman. "It's a stellar example of how a fun and simple idea can harness the internet's potential to contribute to the world's most pressing global issue - hunger."

WFP, Govt blamed for delaying relief food

By CAROLINE WAFULA
Posted Monday, September 27 2010 at 17:50

The World Food Programme (WFP) and the Kenyan government have been faulted for delayed resumption of the relief food distribution programme in parts of the country facing famine.

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Local Members of Parliament in parts of Turkana, Garissa and Tana River districts on Monday accused the WFP of attempting to impose international agencies as lead distributing agencies when the locals preferred the Kenya Red Cross.

The MPs spoke amid reports that some people in Turkana have resorted to feeding on dog meat due to hunger.

They also spoke against the backdrop of the delayed resumption of the Emergency Operation-Protracted Relief and Recovery Programme in some of the areas which the WFP partners with the Government of Kenya to provide relief food and aid.

On Monday, Bura MP Dr Abdi Nuh, Dujis MP Mr Aden Duale and Turkana Central MP Mr Ekwee Ethuro claimed politics were at play and said locals would not allow WFP to force or dictate any agency on them.

However, in a swift rejoinder, WFP denied claims that it was imposing any agency stating that applying agencies must meet the criteria set for selecting distributing partners.

WFP Public Information Officer Ms Rose Ogola said there was a lot of political interference in the Turkana Central case in particular and that distribution was going on in areas that have no interference.

"We don’t make any impositions, Kenya Red cross is our largest distributing partner already in six districts and nobody else has that kind of distribution," she said.

She said the agency has to meet the procedures in Garissa and Turkana Central before it is picked.

"Due process was not followed in Turkana central and there is a lot of political interests and we don’t feel we should be pushed," she said.

The officer said the agency will be meeting with the Government to resolve the issue by the end of the week.

"We cannot just pick anyone, it is a fair process," she said.

WFP in collaboration with the Government selects agencies that are used in food distribution. The Government provides a fraction of what is distributed by the relief agency.

The district steering committees and drought management authorities, according to the MPs who addressed the press at Parliament Buildings, approved the choice of Kenya Red Cross as the WFP cooperating partner on the basis of reliability, efficiency and that it was a home grown agency.

"Kenya Red Cross is the society of choice for the country because it has the capacity, if anyone dies of hunger, WFP will be to blame," Mr Ethuro said.

"It is a shame and irresponsible on the part of WFP," he stated.

The MPs also blame the Government for the delayed commencement of the distribution saying it was not being firm on its decisions.

The project has not kicked off again since the last cycle in July, and this has to do with the procedures that are being followed to select an agency for the task of distribution, the MP said.

"The problem we have is someone trying dictating to us, as long the district committees decides on what they prefer, locals have no problem, but the problem is with the choice of the cooperating agency," Dr Nuh said.

He claimed the agency prefers the German Agro Action as the lead agency in Bura yet it was rated third by the district committee, among the applicants.
The MPs said they were keen on competence of the cooperating agencies that are picked and their efficiency and not about the cost.

People die as row rages

The row between the government and the World Food Programme over the distribution of relief food is quite unfortunate.

Apparently, the relief agency is making demands on who should give out the food, a move the government is viciously opposed to.

But as the two parties engage in an unseemly spat, hundreds of people are starving in the traditionally food-deficient regions of Northern Kenya and other areas.

Admittedly, both sides have valid reasons for holding fast to their positions. But here we are dealing with a matter of life and death.

It is inconceivable that people should be dying of hunger when there is food in stores, just because of conceptual differences between the relevant authorities.

There is evidence that the relief food has been misappropriated and the programme badly managed in the past. But that is not to say that there are no cases of good practices to be emulated.

The government and the WFP must resolve their differences quickly and resume distribution of relief food. People cannot die of hunger just because some bureaucrats differ over the logistics.

Are they heading for a crash?

click here for story on The Economist

Next year Africa could get its first new country, to be called South Sudan, for almost 20 years. But the fledgling state looks perilously weak

Sep 23rd 2010 | JUBA AND KHARTOUM

ON OR about January 9th, the people of southern Sudan should have an opportunity to vote in a referendum on whether to break away from the Republic of Sudan and create their own country. If, as seems likely, they vote overwhelmingly for independence rather than to stay with the north, Africa will get a freshly minted country by the middle of next year.

The government-in-waiting of the new country calls the referendum “the final walk to freedom”. For the Sudan People’s Liberation Movement (SPLM), the southerners’ main party, led by Salva Kiir, it is the culmination of half a century of often bloody struggle for recognition against successive Islamist regimes in Khartoum. These tried to impose an Arab and Muslim culture on the largely black African, Christian and animist south. By the time the fighting stopped in 2005, Africa’s longest civil war had cost 2.5m lives and displaced many millions more. Much of the region was devastated.

The Comprehensive Peace Agreement (CPA) that ended the war set up the semi-autonomous region of South Sudan, to be ruled by the SPLM, as well as a government of national unity in Khartoum led by President Omar al-Bashir, to include the SPLM. The two sides were to work for the country’s unity in a new federal arrangement, but the south also won the right to a referendum on outright secession.

Despite the odd rhetorical nod towards unity, as demanded by the CPA, it is rare to find anyone among the 8m southerners who is not going to vote for independence. Indeed, Juba, the south’s biggest town and capital, exudes a mood of expectation. After a five-year makeover of the government quarter, it gives every appearance of being ready to take its place among the capitals of Africa.

Smart paved roads (and even streetlamps) now lead to brand-new air-conditioned ministerial offices. Workers are putting the finishing touches to a new presidential compound that occupies an entire block in the middle of town. The president’s own palace is a colonial-era building, but it has been completely revamped with a splash of contemporary mock-Pharaonic styling and buttresses tapering towards the upper floors. Behind it is a helipad.

The shiny new presidential buildings include an office suite and large conference and dining halls. The South Korean interior designer enthusiastically invites your correspondent to admire the chandeliers and carpets from his own country. The door frames are from China and the floor marble has been imported from Uganda. But it is not all for work. Adjoining the palace is a sizeable swimming pool and a presidential gym, though the exercise bikes are still in their containers. There is even a pinewood sauna, though you can work up just as much sweat by standing outside.

But beyond the SPLM leaders’ rosy poolside view is a more worrying picture. For a start, it is not certain that the Sudanese government in Khartoum will let the referendum proceed as planned. Even if it does, the outcome will be extremely messy. Moreover, outside Juba the condition of southern Sudan is still dire.

Most southerners think they are marching relentlessly towards independence. But the view from Khartoum is, as ever, utterly different. There, most Sudanese are in a state of denial about the referendum, let alone about independence. When it is mentioned, which is rare, it is only in terms of “maintaining the country’s unity”. Although Mr Bashir has stated publicly that the north will not stop the south if it wants to break off, almost nobody in the north can bring himself to contemplate the probability that, in less than a year, the country will be dismembered and broken into two. Some fear that this attitude could even lead to a new war.

This state of denial stems partly from the fact that the north’s politicians never wanted the south to have a referendum in the first place. It was forced on the north, as part of the CPA, only under extreme pressure from the West. And as only people of southern ethnic origin will be voting in the referendum, the rest of the Sudanese have had little reason to think about it at all. Many politicians from Mr Bashir’s ruling National Congress Party (NCP) genuinely seem to believe that keeping Sudan as one big country is so obviously better for everyone than breaking it up that they have only to do a little bit of campaigning and spend a little bit of money, and the southerners will come to their senses and forget the whole idea.

Denial is a river in northern Sudan

This delusion shows how little northern Sudan’s ruling Arab politicians understand southern sensibilities. In practice, it means that since June, virtually for the first time since the peace deal was signed in 2005, the north has been releasing money for road-building and other development projects in the south. This is an extremely belated attempt to show the benefits of sticking with the Khartoum government. The northerners’ belief that this may suddenly compensate for decades of oppression, aggression and neglect illustrates how lightly many take southern feelings. It is also indicative of the north’s attitude to the referendum that the man appointed to oversee it for Khartoum is Salah Gosh, well known to the CIA and to Britain’s MI6 as a long-serving former head of Sudan’s intelligence services.

Northern efforts to drag out, delay or sabotage the referendum are increasingly blatant. A commission to oversee the referendum has only just been settled upon, with four months to organise the vote. Even with everyone working at full speed it will be barely possible to meet the January 9th deadline. If it is missed, southerners will suspect that the north is trying to deny them their vote, increasing pressure for a unilateral declaration of independence, a doomsday option for the south, to be voted on by its own parliament. This could well provoke another war with the north, as Mr Bashir would refuse to recognise the new country—and many countries, especially in Africa, would side with him.

Just mess it up

The other way in which the north might disrupt the referendum is by stoking dissent and rebellion in the south to reduce the chance of what it calls a “credible” referendum. Northern leaders have been doing this for decades, using rogue groups, such as the brutal Lord’s Resistance Army that originated in neighbouring Uganda, as proxy militias to weaken the south and keep its SPLM off balance.

The SPLM says the north is already up to its old tricks again. One rogue SPLM politician, General George Athor, who alleges that an election for governor in Jonglei state was rigged against him in April, when he stood as an independent, has taken to the bush in the north of the state with hundreds of armed followers. In a recent battle, the SPLM claims to have captured a helicopter and loads of ammunition supplied to the general by the Sudanese (ie, northern) army.

In northern minds, destabilising the south and mucking up the referendum would undermine the legitimacy of any putative new country. Perhaps a new bout of trouble will persuade errant and ignorant southerners to drop their flirtation with secession and come back to the fold.

Can Salva Kiir save the south?

Meanwhile, the south’s own politicians are playing into northern hands by misruling and enfeebling the region on their own. Most of the huge number of willing and devoted outsiders working for international charities or the UN despair over the chronically slow pace of reconstruction over the past five years. The disbursement of foreign money to rebuild the south has been lamentably slow. But many also blame the SPLM leaders in Juba. Even among the SPLM’s usually loyal cadres frustration and criticism are growing.

The UN has produced a list entitled “Scary Statistics” to show how things are going wrong. “It’s as bad as bad can be,” says a senior UN official. The south still has one of the world’s highest maternal mortality and infant mortality rates. Some 85% of adults cannot read or write.

In the fields, so slender are the margins between success and failure that a single bad harvest last year almost tipped the south into famine. More than half the south’s population is on “emergency assistance”, meaning that they will need food handouts this year. Some 1.5m will face “severe food insecurity”. The south has been saved from famine only by American money pumped into the UN’s World Food Programme. And even as malnutrition has increased during the past five years of peace, the SPLM government has spent more than $6 billion of oil revenue, received under a wealth-sharing agreement with the north, not to mention hundreds of millions of dollars in aid. Where, people ask, has the money gone?

The answer is to the army—and the Juba government. The SPLM leadership spends 60% of its income on weapons and army pay, as an insurance, it is argued, against renewed hostilities with the north. Corruption has also become a problem.

The southern centre may not hold

The town of Bor, half an hour by plane down the Nile from Juba, was once a busy trading post but now feels on a different planet. Signs of progress are few. The Dr John Garang Memorial University, named in honour of the SPLM’s former leader who died in a helicopter crash in 2005, was set up in 2008. It has about 100 students and has received $3m from Juba. Some southerners educated in Kenya, Uganda and the United States during the civil war have come back to teach. Bor’s population has grown by about 70% in the last few years, as families displaced in the war have returned. Its central market does a brisk trade.

Yet only in the past year have a handful of brick buildings been built. There is still no completely paved road in Bor or in the entire state of Jonglei. In the rainy season, which can last for over half the year, getting from one side of town to the other, let alone elsewhere in the state, can become impossible. Security in Bor itself has improved, but the roads immediately to the north and south are plagued by bandits. This summer the WFP was feeding 44% of the state’s population of about 500,000. Recent floods may push that figure up.

The state’s governor, Kual Juuk, a former guerrilla who was once close to Mr Garang, laments that the lavish development of the centre of Juba has been at the expense of the rest of the region. This galls him since Mr Garang identified the concentration of development in Khartoum, at the expense of the neglected regions in the south and west (especially Darfur) as a prime cause of Sudan’s civil wars. “The SPLM was supposed to be different, for fiscal and political decentralisation,” he says. “Now we are falling into the same pit.” He argues with the government in Juba but it ignores him. “They are inward-looking,” he says. “It is the same attitude in Khartoum.”

Such disaffection is growing dangerously. The SPLM is not a democratic outfit and barely tolerates criticism. In April’s election, it sometimes resorted to bullying and intimidation to see off independent candidates. But in the south’s incipient state of anarchy, these men, such as General Athor, may become rebels all over again, and head off into the bush to wage war, often backed by their own ethnic groups. Besides General Athor, another losing candidate, David Yau Yau, is at large in Jonglei with hundreds of armed followers in Pibor, in the state’s east.

Such rebels will cause more instability, shut more roads and hamper development even more. They may also open up ethnic cleavages between the various southern groups, especially the Dinka and Nuer, which are the most prominent at the heart of the SPLM.

There is also a worry that some neighbouring countries do not openly support the prospect of southern independence, even though they all signed up for it under the CPA in 2005. In truth, if the south does become independent, it will need all the regional and international help it can muster. Its people’s shared detestation of Arab northerners will no longer be enough to bind them together.