FRED DE SAM LAZARO: The 2010 earthquake that devastated Haiti may still loom large in Americans’ memory, but, in Haiti itself, that was at least three disasters ago, before Hurricanes Tomas last year, Isaac in August, and recently Sandy.
Each storm brought a grim reminder of yet one more ever-present disaster: the deadly cholera epidemic that started 10 months after the quake.
At the cholera ward of Saint Luc’s Hospital just outside the capital, Port-au-Prince, Dr. Jackinson Davilmar says since Hurricane Sandy admissions have doubled from 20 to 40 patients each day.
DR. JACKINSON DAVILMAR, Saint Luc Medical Center (through translator): Most of the new cases are coming from further up the hill in places like Petionville where we had not seen them before. I’m not positive, but perhaps the wells there have been contaminated.
FRED DE SAM LAZARO: Experts believe cholera was brought here by U.N. peacekeepers at the time, a battalion from Nepal. Untreated sewage from this base flowed into a tributary of the ArtiboniteRiver, the major source of water for both washing and drinking.
Cholera is spread by fecal-oral contact. Two years on, 200,000 patients have been sickened, 7,500 have died from the extreme diarrhea and fluid loss. Each flood brings more contaminated water, more cases.
The epidemic prompted massive relief efforts and public campaigns on the streets and in classrooms promoting hygiene and sanitation. Fatalities have dropped from 10 percent of cases early on to about 1 percent.
Still, 600 people have died from cholera this year, many in remote areas, even those unaffected by floods. There’s now plenty of awareness of cholera in Haiti. The biggest challenge for people today is distance.
As the epidemic subsided over the last few months, many treatment centers have been closed in the remote areas. So, getting to places that remain open is a huge challenge. It can take hours. And that delay can be fatal.
Sentiment Joseph, a 27-year-old mother of three, will likely recover, having made it in time to get prompt antibiotics and rehydration therapy. Her husband wasn’t so lucky. He died a week earlier in their home less than an hour away by motorcycle.
SENTIMENT JOSEPH, Cholera survivor (through translator): He took ill around midnight. There was no one to care for the children, no means to bring him in. We didn’t have the money to hire a motorcycle.
FRED DE SAM LAZARO: Across this spartan treatment center run by the Boston-based charity Partners in Health, other challenges were apparent from patient stories.
MAN (through translator): We don’t have hygienic facilities. We treat our water, but don’t have a formal latrine.
MAN (through translator): I was staying in my sister’s home, and I’m not sure she treated the water.
MAN (through translator): There are 14 people living in our house. And it’s very expensive to treat the water for so many people. And our only latrine was destroyed in a road-building project. So, we don’t have that.
FRED DE SAM LAZARO: Cholera, not seen in Haiti for almost a century since 2010, is likely to remain for some time, says Partners in Health physician David Walton.
DR. DAVID WALTON, Partners in Health: Cholera endemic to the region, to the country is the last thing that they needed. Permanent solutions need to be put in play to be able to really stem the tide of this epidemic that is still ongoing.
FRED DE SAM LAZARO: He says cholera’s persistence is a proxy for a much larger rebuilding effort that’s fallen short, one that should have provided far more access to clean water and sanitation.
DR. DAVID WALTON: On a scale of A. through F., it’s a D.
FRED DE SAM LAZARO: At least 360,000 people remain in crowded tent camps, he notes. Other people have rebuilt in poor neighborhoods destroyed in the quake, like this one in the hilly suburb of Petionville.
Water had to be carried in. And there are few toilets, so there’s a threat of cholera.
James Sanvil lives in the U.S., but was visiting family here.
JAMES SANVIL, Haiti: There is no water, no way for them to get water down here, because there’s no water came, like, down here.
FRED DE SAM LAZARO: Kevin Fussell is one of many small providers who have tried to bring relief. He’s a Georgia physician who started a charity to provide safe drinking water.
His group installed clean water facilities into six schools in the central Haitian town of Mirebalais before running out of donated funds.
He says they’d like to put in many more, but have had no luck applying for funds the U.N. has for water projects.
DR. KEVIN FUSSELL, World Water Relief: They’re basically trying to come up wore water solutions for an entire country. And we’re working in a very small region. And they’re looking for bigger global solutions.
My problem with that thinking is that three years later somebody is still thinking about global solutions, when we have real problems right here. And nothing is being done.
FRED DE SAM LAZARO: That’s a complaint that’s widely heard. In water and sanitation projects or anything else, there’s little to show for the billions in aid that came in or was pledged to Haiti, says human rights activist Antonil Mortime.
ANTONIL MORTIME, Human Rights activist (through translator): I have talked to people in the tent camps. If you look at Cite Soleil, you can see that the situation is actually worse.
There’s no change with education, with infrastructure or health care. Corruption, poverty and hunger haven’t decreased.
FRED DE SAM LAZARO: Nigel Fisher, head of the U.N.’s large Haiti mission here, acknowledges the slow pace, but says there has been some progress on the massive rebuilding task, a much smaller number of tent dwellings since last year, for example.
NIGEL FISHER, Deputy special representative of the U.N. Secretary-General: If Haiti were a glass, and it’s gone from being 10 percent full to 15 percent full, let’s recognize that without in any way diminishing the fact that you have still got 85 percent of the glass full.
FRED DE SAM LAZARO: But Fisher says many of the problems were endemic to Haiti long before the earthquake.
NIGEL FISHER: What we’re seeing is people who are in camps because of entrenched poverty. Many of these people were hidden before in slums. They’re now in the open in camps.
And that is a function of underdevelopment. It’s a function of weak governance. It’s a function of lack of alternatives, and which these people faced before.
FRED DE SAM LAZARO: He says one of the biggest problems is that Haiti’s government, crippled by the quake and a corrupt reputation, hasn’t been able to lay down national priorities for the rebuilding.
That’s largely been led by foreign non-government organizations, at least 10,000 of them, everything from small church groups to the large international agencies. NGOs have received more than 90 percent of all aid dollars.
DR. DAVID WALTON: The amount of redundancy with the more than 10,000 NGOs that the U.N. special envoy’s office has estimated exist Haiti just leaves one wondering where all the money has gone.
And, frankly, if you look at, as they have done, where all the money has gone, hardly any of it has gone to strengthen the government.
FRED DE SAM LAZARO: Partners in Health, which has been in Haiti for 25 years, is trying to restore what it says is the appropriate role for the government.
DR. DAVID WALTON: So, 60 percent of our beds have medical gas. They also have electrical receptacles and data capacity.
FRED DE SAM LAZARO: The group raised $22 million to build a 300-bed state-of-the-art teaching hospital in central Haiti. However, it then partnered with Haiti’s Ministry of Health to design and run it. It will turn over the hospital to the government in 10 years.
Dr. Walton says Haiti can never be rebuilt unless it has a strong, accountable government.
DR. DAVID WALTON: It would be so much easier for us to run it the way we wanted to run it and not coordinate with anybody but ourselves, because, hey, we’re really smart, or at least we think we are.
FRED DE SAM LAZARO: And you are the guys with the money.
DR. DAVID WALTON: We are the guys with the money. And, again, NGOs don’t guarantee the right of health to citizens of any country. But the government does. And we see ourselves as supporting the government.
FRED DE SAM LAZARO: President Michel Martelly cut the ribbon on the new hospital, vowing his administration will do better.
International donors, who have withheld half the $5 billion they pledged to rebuild Haiti, will closely watch how projects like this hospital fare.
For many ordinary Haitians, the goal, as one health worker put it, is to make it to the end of each day alive.