1. Facing Cholera : Psychosocial support response to the outbreak

2.  Cholera outbreak in Haiti  October 2010 : First cholera outbreak since sixty to hundred years. For the population it is a new and unknown disease.  A vast prevention campaign is launched by Ministy of Health and NGOs :  Distribution of flyers and pamphlets  Radio / SmS messages and TV spots  Sound trucks  Mass sensitization campaign strategy

3.  What role for Psychosocial Support in the Humanitarian response to Epidemic outbreak (Cholera in Haiti) ?  Context analysis : Understanding the psychological and social dimensions of the epidemics (context analysis) : focus group discussions facilitated in the first weeks of the epidemics lead to the idenfications of belief and perceptions surrounded the cholera outbreak  Community mobilisation in order to facilitate the setting up of CTCs  Prevention and awarness sessions with psychosocial dimensions (fear, stigmatisation,…) as an entry point  Conflict mediation (in case of stigmatisation / or conflict link to the setting up of CTC;…)  PS support to patients and their families in CTCs (PFA)

4.  Understanding the psychological, emotional and social context of the cholera outbreak  Beliefs and perceptions :  “It is a poison brought by foreigners to divide us”  “It is a disease brought by foreigners to exterminate us and take our land”  “Cholera does not exist in our country. It is something else which is killing us”  “It is a disease brought by NGOs in order to get more money”  “Each time we have elections in our country there is a disease outbreak. It is political. It is made to divert our attention”  “It is a punishment from God”  “It is another divine sign (after the earthquake) that the end of the world will come soon”  « Mikwob pa touye ayisyien » : Microbes don’t kill Haitians  « Kolera powder » (belief that the voodoo believers have created a powder to contaminate water with powder »

5.  Emotional and social consequences  Strong feeling of fear and insecurity due to –the fact that cholera is an unknown disease in the country –unclear understanding on the origin of the disease –suspicions that cholera is a political strategy aimed at harming Haiti –unclear understanding on how cholera is transmitted –unclear understanding on how cholera can be treated –cholera is linked to a basic, daily and vital need : to drink and eat –the fact that death can occur in just a few hours –the belief that cholera is a form of curse (especially amongst Voodoo believers).  Stigmatisation and isolation of patients and/or former patients.  Violence (against NGOs, CTCs, Voodoo believers)  Grief and sadness due to the loss of beloved ones  Understanding the psychological, emotional and social context of the cholera outbreak

6.  Beliefs on the way cholera is transmitted :  Can be transmitted by air  Can be transmitted by mosquitoes and flies  Can be transmitted by the dust  Can be transmitted by skin contact (through the sweat)  Understanding the psychological, emotional and social context of the cholera outbreak

7.  Drafting of a context analysis note on community beliefs and perceptions on cholera  Publication in ‘intervention’ (Journal of the WarTrauma Foundation)  Note used and published by various Humanitarian agencies (WHO web site / DSO, OIM, etc.)  Understanding the psychological, emotional and social context of the cholera outbreak

8.  A specific sensitisation methodology was developped using group discussion and based on :  active and non jugdmental listenning facilitation :  beliefs and perceptions are welcomed, listened to and not denied  Allow to build trust and allow blocking feelings to be released  Pear education process : community members are sharing their thoughts and knowledge – facilitator only build on existing valid knowledge  Psychosocial team intervention: awarness and sensitisation on cholera

10.  Support to patients in CTC  Psychological First Aid (patients are facing a critical events)  Rebuilding social links and reducing stigmatisation  Drawing with children  Meetings with family in order to support return to homes  Facilitating mourning process – Setting up of a Mourning tent in a CTC in Carrefour in order to allow families to say a last good bye to their beloved ones  Psychosocial team intervention: Support to Patients in cholera treatment centres (CTC)

11.  Conflict mediation following conflicts linked to  Establishment of CTCs  Assassination of 45 voodoo believers and Voodoo priests in Grande Anse  Conflicts opposing NGO and community members (NGO accused of spreading cholera)  Psychosocial team intervention: Community conflict mediation

12.  Facilitation of training and group sessions with the voodoo priests  Voodoo priests very vulnerable to cholera because represent the first health services provider in Haiti  RCRC duty as neutral and impartial to oppose stigmatisation of one group of the population such as the voodoo community  Understanding the specific value and beliefs system of the voodoo community in order to build bridges with other communities  Psychosocial team intervention: working with the voodoo community

13.  Sensitisation of 70 journalists throughout the country on psychosocial aspects of cholera  Participation in three radio broadcast on psychosocial aspects of cholera  Psychosocial team intervention: Media