July 24, 2017

In the Port-au-Prince, Haiti neighborhood of Martissant, Doctors Without Borders/Médicin Sans Frontières (MSF) is working to improve water quality and protect residents from cholera and mosquito-borne viruses like Zika, dengue, and chikungunya. The Marengwen project—which takes its name from the Creole word for mosquito—is an ambitious initiative with the goal of reducing populations of the Aedes mosquito, a major source of disease in region.

In the brutal heat of the Caribbean, houses are designed to let the breeze in, not to keep mosquitoes out. As a result, the 260,000 people living in Martissant, one of the country’s largest slums, are easy prey for the Aedes mosquito. The insect lays its eggs in standing water pooled in abandoned tires, discarded beer cans, or the large puddles of unauthorized dump sites, all of which are common in the area. As the mosquito population grows, so too does the threat from potentially lethal diseases. In addition, in the aftermath of the devastating earthquake that hit Haiti in 2010, cholera—which thrives in poor sanitary conditions—has become endemic in country, with seasonal peaks regularly triggering emergency interventions. Every month, anywhere from 10 to 70 patients require care in the cholera tent of MSF’s emergency medical center in Martissant. 

In response to these threats, MSF launched a project intended to benefit the Martissant community while, at the same time, providing a blueprint for the organization’s water sanitation practices elsewhere. First, MSF teams combed the slum for six months, treating communal water sources for the cholera vibrio. Next, they sprayed 350 public places—churches, schools, and the concrete gullies that crisscross the neighborhood—to exterminate as many mosquitos as possible. Innovative new traps were used to allow the team to better analyze the mosquito population and to adapt a response. One of the traps is loaded with a cartridge that attracts mosquitos by replicating the odor of humans. “One day I came to the office and it smelled so bad I thought there was a dead cat somewhere. But the staff had just stored all our cartridges in my office. We humans just don’t realize how bad we smell,” says Pierre Trbovic, coordinator of the project.

Martissant is a difficult place to live and a difficult place to work. Few public services reach the destitute community, and urban gangs control the streets. However, MSF is an established presence in the neighborhood and has provided care to an average of 4,300 local patients every month since 2007. The Marengwen project is designed to complement the other medical activities in the slum and has helped MSF remain visible in the neighborhood. In addition to treating the water, outreach teams worked with community leaders and knocked on every door—40,000 to 50,000 houses—teaching locals to identify and destroy mosquito breeding places and to treat water with locally available chlorine. The project helped develop a network that will allow MSF to improve its emergency response in the event of an outbreak.

The Marengwen project was a major undertaking, requiring the participation of 110 MSF staff, along with an additional staff of 35 Haitians from the Ministry of Health, working as community liaisons. The endeavor was complicated by the fact that maps of Martissant are difficult to find and of varying quality. Trbovic explains: “We had to teach people from the area how to read a map, so they were able to show us where we should treat water or where we could organize large scale meetings with the community. They basically rediscovered their very own streets in two dimensions. The first lesson we learned was that we would have saved precious time if we could equip each staff person going door-to-door with individual tablets to encode data. Well, we learn by doing.”

In order to fully control a mosquito population in an open, urban environment like Martissant, these efforts will need to be repeated regularly. For the moment, community outreach activities led by staff from the Ministry of Health and others continue, though on a smaller scale. A major goal of the project will be realized when the operational research is completed. Thanks to this research, MSF will be better equipped to engage more effectively in similar water sanitation and mosquito control efforts in the future, in Haiti and elsewhere. 

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