TOPICS > Health

Cholera Outbreak Compounds Haiti’s Woes

January 14, 2011 at 12:00 AM EST
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Jeffrey Brown looks at the battle against a cholera epidemic in Haiti, one year after a devastating earthquake upset an already fragile infrastructure.
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JEFFREY BROWN: Now, we continue our look at Haiti one year after the earthquake — tonight, a battle against an epidemic unfolding in the countryside and cities.

In the village of Saut-d’Eau, high in Haiti’s central plateau, mourners gathered to share their grief over loved ones lost to cholera. A Haitian psychologist working with the aid group Partners in Health had organized the meeting. One by one, people told their stories.

The first man described his 5-year-old son, one minute playing soccer, and then, soon after, falling gravely ill. His son, he said, died in his arms.

Another man told of losing several family members and friends. He said, “I feel like a bird left without a branch to land on.”

Even as they spoke, in a tent nearby, the sick were being cared for. This small facility, miles from a major treatment center over bone-crushing dirt roads, has seen about 1,000 people, and at least 30 have died here.

MAN (through translator): Cholera is breaking people in this area. It’s killing us poor people.

JEFFREY BROWN: Nationwide, in the first outbreak of cholera this country has seen in more than 100 years, there have been some 140,000 cases, with the death toll now well over 3,000. The numbers exploded quickly over just several days beginning in late October.

DR. DAVID WALTON, Partners in Health: That was emblematic of how quickly this overtook kind of the communities, and how much our focus had to be shifted away from primary care and other types of care.

JEFFREY BROWN: Dr. David Walton set up the main Partners in Health cholera treatment center, a makeshift camp of tents just outside the small city of Mirebalais.

So, has the response that you have seen been adequate?

DR. DAVID WALTON: I would say that there’s a strategy in place that I think is a sound strategy of community-based interventions, of treatment centers, of an architecture of a response. The resources and the rapidity of the response have been too slow.

JEFFREY BROWN: One young man had just been carried into the treatment center. His aunt told me they had come from a village 10 miles away.

WOMAN (through translator): I suspected it could be cholera, because, this morning, the diarrhea took hold of him. We just see the sickness fall upon on us, but we don’t know how we catch it.

JEFFREY BROWN: One of the tragedies of the outbreak is that the disease is so easy to treat. Cholera is a bacterial infection that spreads through human waste in contaminated water. Its victims suffer intense diarrhea, a catastrophic flushing out of all fluids, that can cause bodily functions to fail within hours.

If caught in time, rehydration and antibiotics will save the great majority of people. But so many here live in remote areas, far from help.

Dr. Hebert Thelusma runs the clinic.

DR. HEBERT THELUSMA, clinic (through translator): Of the people who live far, far away, we lose many. They end up dying en route or at home, because they don’t have the means to get to care.

JEFFREY BROWN: This beautiful region along the Artibonite River is ground zero for an outbreak of cholera that’s brought a new public health emergency to this nation, one still reeling from January’s earthquake and so much more.

Nearly 60 percent of the country’s population lives in the countryside in small communities. Life in these rural areas is a daily struggle. Wood and food must be fetched and carried. There’s often no electricity, toilets, or access to clean drinking water.

The river is a lifeline used by farmers tilling rice paddies, families bathing, women washing clothes. But all of this is a breeding ground for disease, including cholera.

NADIA GUERRIER, volunteer, Oxfam (through translator): The person usually comes in and has an upset stomach, they have had diarrhea and the symptoms of cholera.

JEFFREY BROWN: Nadia Guerrier is a young volunteer working with the aid group Oxfam. At her tiny way station by the river, she showed me how she mixes a chlorinated solution of drinking water for villagers.

In Kacite (ph), where she lives, Oxfam is working with locals to get out the word about preventing the disease. They test water for contamination, offer purification tablets, and explain that the chlorine taste, while not to the villagers’ liking, is necessary.

New latrines have been built that can be shared and last many years. The message, carried by a local community leader and an aid worker, is simple, if not always easy to follow in practice: Drink only treated water, wash your hands, and use the latrines.

SILNA ANGLADE, peer educator, Oxfam (through translator): I come around every three days to get the word out and help people understand that cholera can kill them very easily.

RALPH PIERRE CAUVIN, community health worker, Oxfam (through translator): The emphasis is to make sure that the personal hygiene is the most important thing to prevent cholera.

JEFFREY BROWN: Such messages are now everywhere around the country.

While cholera began in the countryside, a great fear has been that it will sweep the overcrowded city as well, into places like this. La Saline is one of Port-au-Prince’s notorious slums. This is a kind of unofficial community of thousands who live without municipal services. Conditions here are dreadful, with fields and ditches of human waste and garbage.

IVAN GAYTON, Doctors Without Borders: Epidemiologically, this area is terrifying. You have got salt. You have got feces everywhere. You don’t have much municipal water service. So, it’s of tremendous concern. This is an area where we would expect to see potentially really dangerous level of transmission.

JEFFREY BROWN: Ivan Gayton with Doctors Without Borders took us to a makeshift reservoir, a small basin of water from a broken pipe on this area’s one paved road. Residents, mostly women and children, gather here all day long to fill their plastic buckets. Volunteers for the aid group offer purification drops, a quick squirt, for anyone who wants it.

MAN (through translator): Before, the water was no good. It had many diseases. But now it’s clean.

JEFFREY BROWN: How do you get the word out to people?

IVAN GAYTON: No need. We just set up here, and there’s already people coming to this unofficial water point. All we do is sit here with our chlorination. People really know that there’s a problem, and they know that something need — they need something, so they’re actually quite eager.

JEFFREY BROWN: And there are signs of progress. Gayton says there’s been as many as 500 cases in this area, but the number has fallen recently. A giant slum, makeshift approaches, but this qualifies as a success story in the cholera fight.

The risk for infection in the tent communities that dot the city is actually not as high, because international organizations like the Red Cross provide sanitation services and fresh water regularly.

But, even as aid groups try to head off the epidemic, questions remain: How did this outbreak happen? Why now, amid the massive humanitarian relief effort after the earthquake?

The immediate focus has been here: a U.N. base manned by peacekeepers from Nepal on a tributary of the Artibonite River. The U.N. first denied its soldiers had channeled their waste into the river. Subsequently, the strain of cholera now in Haiti was determined to be one predominant in Asia. And, after much criticism, the U.N. has just named a panel to investigate.

Nigel Fisher is the U.N.’s humanitarian coordinator in Haiti.

NIGEL FISHER, deputy special representative, U.N. Secretary-General: We have had a number of epidemiologists here with different viewpoints, one from France saying, yes, it looks like it has to be the Nepalese, others saying, no, we don’t think — you can pinpoint those, others saying, it’s a climatic factor.

So, I hope this independent commission can at least start to really dig in and come up with — with a point. In retrospect, yes, maybe we should have had the — the commission much sooner.

JEFFREY BROWN: Whatever the results, everyone we talked with reminded us that disease in Haiti is a longer-term problem, one that predates the earthquake, and ultimately relies on building a proper water and sanitation infrastructure.

The Haitian government has a proposal to make a start at that, as a part of the larger reconstruction plan. It’s awaiting funding. For now, the hope is to contain the cholera outbreak in Haiti. There are some signs it may have peaked in certain areas, even as it spreads to new ones.

From the city to the countryside, health experts say, cholera may well be here to stay, endemic to Haiti, another disease of poverty in this nation struggling to survive.