1990: Cholera campaign -- lessons learned

1
1990 Cholera campaign -- lessons learned

• Consortium of Universities
• Estela
  Roeder

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Cholera in the Americas

• The return of cholera to the Americas in 1991
  marked the beginning of the first epidemic of
  this disease in the 20th century, with almost
  400,000 cases and a death toll of 4,093 in the
  first year, giving the warning signal with regard
  to surveillance for the control of this pandemic,
  which had been the scourge of mankind for
  centuries.
• In January 1991, Vibrio cholerae 01 was detected
  in a coastal village of Peru, signalling the
  arrival of the seventh cholera pandemic to Latin
  America. By 2000, the epidemic had reached 21 of
  the 35 countries in the Region of the Americas.
• The following case history, prepared by Lic.
  Estela Roeder, Head of Communications of the
  Peruvian Ministry of Health at the time, presents
  the context, strategies, analyses and lessons
  learned from this cholera episode.

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Why do epidemics occur?

• Epidemics have different causes and effects
  in different regions / countries, depending on
• a) Level of economic development
• b) Educational level
• c) Cultural aspects habits, customs
• d) Government policies on health and the
  environment
• An epidemic shows up the living conditions

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The early 1990s

• When the epidemic broke out, the Peruvian
  government had been in office for 6 months.
• Peru was going through an acute economic crisis,
  in view of the negative results of the former
  administration.
• Outside Peru, a new war was starting the Gulf
  War (Irak invaded Kuwait).

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Cholera in Peru

• The Minister of Health was a person with
  technical and professional prestige at the
  international level.
• He had a team of qualified officials
• There was a desire to change things in the
  Ministry
• Institutional expectations were great
• The people of Peru were demanding better health
  services (quality of health care, resources, and
  infrastructure)
• NGOs were leaders in the topic

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Cholera in Peru (Continued)

• In January 1991, the summer campaign for the
  control of diarrheal diseases (high infant
  mortality rate) had just been approved and was
  to be launched in February/March
• Basic sanitation conditions were precarious more
  than half the population of Peru did not have
  piped drinking water and had no drainage system
• Health education was not developed
• The reorganization process in the Ministry of
  Health was incipient

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How the cholera arrived

• The cholera in Peru was part of the seventh world
  pandemic. Asian countries had the highest
  incidence.
• Perus health personnel had experience managing
  diarrheal diseases with oral rehydration salts
  (life-saving packets community Oral
  Rehydration centers health education), but they
  knew nothing about cholera.

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How the cholera arrived (Continued)

• At the end of January, a few adults (men and
  women) in Chancay, north of Lima, showed signs of
  acute diarrhea.
• At the beginning of February, the cases
  multiplied massively
• The Minister of Health was on an official mission
  outside the country
• The media started publishing headlines on the
  topic. Pressure by the media.
• On February 4, the Director of the National
  Health Institute announced to the country the
  presence of cholera (with the consent of the
  President of Peru)

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A campaign is approved

• The campaign was called a stop cholera
  campaign, because of the emergency situation
  (thousands of cases)
• The Communications Bureau of the Ministry of
  Health assumed responsibility for the campaign
• International cooperation arranged to support the
  informational/educational activities with
  technical assistance (rather than financial)
• NGOs and social organizations offered their help
• The mass media offered free spaces

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The strategies

• Institutional
• National Committee (Command) for the Fight
  against Cholera (Communications Bureau
  participates)
• Daily press releases approved by the Ministry and
  the Committee. Selection of the informational and
  educational topics in keeping with the process of
  the epidemic (Epidemiology Room)
• Selection of official spokespersons
• Media cooperate in the reception and delivery of
  funds / donations

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The strategies (Continued)

• Alliances
• With the other Ministries (competition)
• With the municipalities
• With NGOs (reproduction of communication material
  and products)
• With community-based organizations
• With cooperation agencies
• With the media

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Communication tasks

• Design basic and secondary messages
• Work closely with the media
• Appoint recognized spokespersons (decision of the
  Ministry)
• Use clear, simple statements (consensus)
• Produce informational material (posters, flyers,
  banners)
• Prepare graphic arts for posters for the NGOs

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Communication tasks (Continued)

• Produce a video spot with the basic messages
  (Institute for Research on Nutrition / Banco de
  Crédito)
• Produce a radio spot for all radio stations
  throughout the country
• Print information sheets for journalists
• Prepare graphic arts for the newspapers
• Invite journalists to key events

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Main messages

• 1. Wash your hands
• 2. Boil your water
• 3. Eat cooked food
• Campaign motto
• LETS STOP THE CHOLERA!

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SWOT Analysis

• STRENGTHS
• Immediate decisions were taken to prepare the
  health services
• The health personnel participated actively
• Institutions and companies gave their support
• Cooperation agencies congratulated Peru on its
  handling of the situation

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SWOT Analysis (Continued)

• STRENGTHS
• A stop cholera campaign was designed and
  implemented successfully
• The media played a key role publishing the
  official press releases and informing about
  measures for prevention and control

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SWOT Analysis (Continued)

• WEAKNESSES
• The President kept quiet at the beginning and
  then assumed a contradictory discourse (The War
  of the Cebiche)
• The other ministries started to compete with the
  Ministry of Health (Agriculture, Fisheries . . .)
• There appeared experts outside the Ministry of
  Health

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SWOT Analysis (Continued)

• WEAKNESSES
• The recommendation not to eat raw fish was made
  without coordinating with the fisheries sector
• Initial inaccurate information (boil water for 15
  minutes)
• Wave of social protests (using gas / kerosene to
  boil the water not being able to go to the
  beach tourism restricted)

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SWOT Analysis (Continued)

• OPPORTUNITIES
• Create an image of credibility in a situation of
  threat to public health
• Re-structure the health system (emergencies)
• Generate institutional philosophy and commitment
• Propose medium- and long-term programs for basic
  sanitation

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SWOT Analysis (Continued)

• THREATS
• Cholera might remain
• Loss of prestige at the international level
  (exports)
• Growth of social protest
• Intensification of poverty
• Delaying of other institutional priorities
  (decentralization)

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Lessons learned

• BAD THINGS
• Contradictions at the government level
• Latrines installed throughout the country
• The population was frightened

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Lessons learned (Continued)

• GOOD THINGS
• Deaths of hundreds of thousands of Peruvians were
  prevented
• Social deficiencies were brought into evidence
• Health personnel acted with a great sense of
  responsibility
• Civil society had an active participation
• The media played an educating role rather than
  indulging in sensationalism

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Communicationally speaking

• The three basic messages were assumed
• The population changed its behavior
• Greater importance was attached to communication
  (more support / resources)
• The stop cholera campaign was a prologue to the
  educational campaign for 1991
• It was a starting point for the development of
  new health communication models