Tag Archives: cholera

Root Cause

New study finds that cholera vaccine helps protect community

By Kim Smiley

There are an estimated 3 to 5 million cases of cholera worldwide each year, believed to cause more than 100,000 deaths annually.  Cholera is rare in developed nations, but has been pandemic in Asia, Africa and Latin America for decades.  Researchers continue to search for an effective method to prevent cholera outbreaks.  A recent study found that a cheap oral vaccine is an effective tool to help prevent the spread of cholera.  The vaccine is not a perfect solution, but the study found that when two-thirds of the population was given the vaccine, cholera infections in an urban slum were reduced by nearly 40 percent.

The problem of cholera infections can be analyzed by building a Cause Map.  A Cause Map is a visual root cause analysis that intuitively lays out the cause-and-effect relationships of the multiple causes that contribute to an issue.  A Cause Map is built by asking “why” questions and documenting the answers in cause boxes.  To see how a Cause Map of this issue could be built, click on “Download PDF” above.

So why are so many people infected with cholera each year? Cholera is not generally passed from person to person and is predominantly spread through drinking water contaminated with cholera bacterium.  The feces of an infected individual carry cholera bacterium.  Cholera outbreaks occur in areas where there is a person infected with cholera in a location with poor sanitation infrastructure and inadequate water treatment.

Many efforts to reduce the number of cholera cases have focused on providing clean drinking water and providing sanitization equipment.  A recent study looked at three populations in Bangladesh: one was only given the vaccine, the second was given the vaccine, a hand-washing station and taught how to sterilize drinking water, and no intervention was done on the third population. The results showed that the vaccine alone was nearly as effective at preventing cholera as providing the vaccine along with a hand-washing station and instructions on sterilizing drinking water.  In the study, people were given two doses of the vaccine which costs about $3.70.

In an ideal world everyone would have access to clean, safe drinking water, but the resources required to build the needed infrastructure are not likely to be available any time in the near future.  Having a relatively cheap vaccine that is proven to slow the spread of cholera during an outbreak should prove to be a powerful tool in situations where access to clean water is limited.

Root Cause

United Nations Sued for Role In Haitian Cholera Epidemic

By Kim Smiley

A class action law suit has been filed against the United Nations (U.N.) on behalf of Haitian families afflicted by the cholera epidemic that has been raging since 2010.  Many believe that cholera was inadvertently brought to Haiti by U.N. peacekeeping forces.

Some of the basic facts are still debated, but one that is known is that Haiti is experiencing the worst cholera epidemic in modern history with thousands of new cases each month. Nearly 7 percent of the Haitian population has had cholera since 2010.  It’s estimated that around 8,400 people have died of cholera and more than 685,000 have been sickened by the disease.

So why is the U.N. being blamed for this epidemic? A Cause Map, or visual root cause analysis, can be used to explain what many believe occurred.  All causes that contributed to an issue are captured on the Cause Map, which illustrates the cause-and-effect relationships between them.  In this case, people became infected with cholera after drinking contaminated river water.  Many believe that the river was contaminated when sewage leaked from a U.N. camp near the river with inadequate sanitation facilities.  U.N. peacekeepers from Nepal were stationed at the camp and cholera, specifically a nearly identical strain of cholera, was present in Nepal at the time.  It’s assumed that at least one person in the camp had cholera and dangerous wastes managed to contaminate the river. The cholera epidemic seems to be a deadly case of unintended consequences that occurred when the U.N. attempted to aid Haiti following a devastating earthquake.

Once cholera got a foothold in Haiti, the epidemic exploded.  The population had little immunity to the disease because a case hadn’t been seen in Haiti in over a century prior to 2010.  Haiti lacked the sanitation and medical facilities to quickly contain a cholera epidemic.  People continued to drink water from the river because there weren’t many other options. The country had also suffered major damage from the 7.0 magnitude earthquake that hit on January 12, 2010.  Medical facilities, transport facilities, communication systems and all the things a country needs to battle an epidemic had been significantly impacted by the earthquake.  Basically, it was a perfect recipe for a disaster.   A sick U.N. soldier may have brought cholera to Haiti, but the conditions in the country amplified the situation.

The world is still struggling to understand the cholera epidemic and determine what lessons learned should be applied going forward.  Clearly there is something to learn about the need for sufficient sanitation so that illness doesn’t spread unnecessarily.  The U.N. may potentially want to screen troops more closely before stationing them on foreign soil or implement other changes to help prevent anything like this from occurring in the future.  It’s also a powerful reminder to be aware and on the lookout for unintended consequences whenever a solution is implemented.  For example, the U.N has always had legal immunity, but some believe that may change as a result of the cholera lawsuit.   It’s impossible to predict if a verdict against the U.N. would impact future U.N. aid efforts, but it’s easy to imagine that it could have damping effect on their efforts, causing a whole other wave of unintended consequences to occur.

To view a high level Cause Map of the cholera epidemic in Haiti, click on “Download PDF” above.

Root Cause Analysis

Cholera Outbreak in Haiti

By ThinkReliability Staff

Although the World Health Organization (WHO) has never seen cholera in Haiti before, it’s not a great surprise that an epidemic has spread through crowded makeshift camps where people have been living since the earthquake in January.  Unsanitary conditions frequently lead to outbreaks of the disease and in situations where there is very limited access to healthcare and clean water, death rates are often high.   The death rate in Haiti was nearly 10% at the beginning of the outbreak. It’s now decreased to 7.7% which is still well above the 1% death rate threshold accepted by the United Nations (UN).

We can do a closer examination of the causes contributing to this issue in a Cause Map, or visual root cause analysis.  The first step to the analysis is to capture information about the issue and define the problem with respect to an organization’s goals.  The problem can be defined as a cholera epidemic with a high death rate.  It was first discovered, or at least reported, in November of 2010 at makeshift camps in Haiti.  We’ll use the goals of the Haitian government to determine impacts.  At least 284 people have died and 3,600 people have been infected with cholera. This is an impact to the population safety goal.   The high death rate indicates a failure of population services from the government.  The environmental goal is impacted by the epidemic spread of the disease, and  the financial goal is impacted by the cost of treatment of those afflicted.

The second step of the analysis is to determine the causes that led to the impacted goals.  The high number of deaths results from the high number of infections and the high death rate.  Infections are caused by ingestion of contaminated food and water.  The bacteria that causes cholera is spreading due to heavy rains and the large number of people living in the unsanitary conditions.  The overcrowding in the camps is due to the earthquake that hit Haiti on January 12, 2010.  As previously mentioned, it’s unclear how the  bacteria got there in the first place, but not surprising that it did.  The high death rate is due to untreated dehydration.  Severe diarrhea is a symptom of a cholera infection, and with inadequate medical care and lack of access to clean water, the dehydration can quickly become severe enough to lead to death.

Support organizations like the WHO are desperately trying to stop the spread of the epidemic and reduce the rate of death.  However, it’s clear they have their work cut out for them, given the current circumstances.