Open Access Open Access  Restricted Access Subscription or Fee Access

Community health facility preparedness for a cholera surge in Haiti

Linda Meta Mobula, MD, MPH, Gabrielle A. Jacquet, MD, MPH, Kristin Weinhauer, MSN, MPH, Gladys Alcidas, RN, MPH, Hans-Muller Thomas, MD, MPH, Gilbert Burnham, MD, PhD


With increasing population displacement and worsening water insecurity after the 2010 earthquake, Haiti experienced a large cholera outbreak. Our goal was to evaluate the strengths and weaknesses of seven community health facilities’ ability to respond to a surge in cholera cases.
Since 2010, Catholic Relief Services (CRS) with a number of public and private donors has been working with seven health facilities in an effort to reduce morbidity and mortality from cholera infection. In November 2012, CRS through the Centers for Disease Control and Prevention (CDC)’s support, asked the Johns Hopkins Center for Refugee and Disaster Response to conduct a cholera surge simulation tabletop exercise at these health facilities to improve each facility’s response in the event of a cholera surge. Using simulation development guidelines from the Pan American Health Organization and others, a simulation scenario script was produced that included situations of differing severity, supply chain, as well as a surge of patients.
A total of 119 hospital staff from seven sites participated in the simulation exercise including community health workers, clinicians, managers, pharmacists, cleaners, and security guards. Clinics that had challenges during the simulated clinical care of patients were those that did not appropriately treat all cholera patients according to protocol, particularly those that were vulnerable, those that would need additional staff to properly treat patients during a surge of cholera, and those that required a better inventory of supplies.
Simulation-based activities have the potential to identify healthcare delivery system vulnerabilities that are amenable to intervention prior to a cholera surge.


cholera, emergency, preparedness, healthcare, surge, Haiti

Full Text:



United States Geological Survey: Magnitude 7.0 Haiti Region. Tectonic Summary. January 12, 2010. Available at Accessed August 23, 2013.

CDC/MSPP: Haiti Cholera Training Manual: A Full Course for Healthcare Providers. Ministry of Health and Population in Haiti/US Centers for Disease Control and Prevention, 2011: 31. Available at

Farmer P, Almazor CP, Bahnsen ET, et al.: Meeting cholera’s challenge to Haiti and the world: A joint statement on cholera prevention and care. PLoS Negl Trop Dis. 2011; 5(5): e1145.

MSPP: National Plan for the Elimination of Cholera in Haiti 2013-2022. February 2013. Available at〈=pt. Accessed August 23, 2013.

Savoia E, Testa MA, Biddinger PD, et al.: Assessing public health capabilities during emergency preparedness tabletop exercises: Reliability and validity of a measurement tool. Public Health Rep (Washington, D.C.: 1974). 2009; 124(1): 138-148.

Cowan ML, Cloutier MG: Medical simulation for disaster casualty management training. J Trauma. 1988; 28(1 Suppl): S178-S182.

Eason MP. Sarin exposure: A simulation case scenario. South Med J. 2013; 106(1): 55-62.

King DR, Patel MB, Feinstein AJ, et al.: Simulation training for a mass casualty incident: Two-year experience at the Army Trauma Training Center. J Trauma. 2006; 61(4): 943-948.

Klima DA, Seiler SH, Peterson JB, et al.: Full-scale regional exercises: Closing the gaps in disaster preparedness. J Trauma Acute Care Surg. 2012; 73(3): 592-597; discussion 597-598.

Leiba A, Goldberg A, Hourvitz A, et al.: Lessons learned from clinical anthrax drills: Evaluation of knowledge and preparedness for a bioterrorist threat in Israeli emergency departments. Ann Emerg Med. 2006; 48(2): 194-199, 199. e1-e2.

Olsen ME: Use of medical simulation to teach bioterrorism preparedness: The anthrax example. South Med J. 2013; 106(1): 49-54.

Patel RM, Crombleholme WR: Using simulation to train residents in managing critical events. Acad Med. 1998; 73(5): 593.

Hirshberg A, Holcomb JB, Mattox KL: Hospital trauma care in multiple-casualty incidents: A critical view. Ann Emerg Med. 2001; 37(6): 647-652.

Pan American Health Organization: Cholera Alert! A Simulation Exercise (Georgetown, Guyana). 1992. Available at Accessed August 23, 2013.

PAHO: Guidelines for Developing Emergency Simulations and Drills. December 2011. Available at index.php?option=com_content&task=view&id=1637&Itemid=807. Accessed August 23, 2013.

International Centre for Diarrhoeal Disease Research B: Management of Cholera and Other Acute Diarrhoeas in Adults and Children. 1980. Available at Accessed August 23, 2013.

OXFAM: Cholera Outbreak Guidelines: Preparedness, Prevention, and Control. June 2012. Available at Accessed August 23, 2013.

WHO: Cholera Outbreak: Assessing the Outbreak Response and Improving Preparedness (Global Task Force on Cholera Control). 2004. Available at Accessed August 23, 2013.

Institut Haitien de Statistique et d’Informatique (IHSI): Population Totale, Population de 18 ans et plus menages et densites estimes en 2009. March 2009. Available at Accessed August 23, 2013.

Nelson C, Lurie N, Wasserman J, et al.: Conceptualizing and defining public health emergency preparedness. Am J Public Health. 2007; 97(Suppl 1): S9-S11.

Biddinger PD, Cadigan RO, Auerbach BS, et al.: On linkages: Using exercises to identify systems-level preparedness challenges. Public Health Rep (Washington, D.C.: 1974). 2008; 123(1): 96-101.



  • There are currently no refbacks.