Haitians wash clothes in a stream on Jan. 8, 2011; Photo by Mario Tama/Getty Images
With more than 7,000 dead and half a million people sickened, a U.N. health agency is calling the cholera outbreak in Haiti “one of the largest epidemics of the disease in modern history to affect a single country.”
At a news conference Wednesday, the presidents of Haiti and the Dominican Republic and health officials from the Pan American Health Organization/World Health Organization, the U.S. Centers for Disease Control and Prevention, and UNICEF called on international donors to fund new water and sanitation infrastructure projects in Haiti.
In a recorded message, Haitian President Michel Martelly said his country desperately needs infrastructure upgrades to fight the outbreak which has now spread to neighboring Dominican Republic. “Decades of neglect and the failure to invest in these areas have led to many illnesses associated with the consumption of contaminated water, lack of education in the practice of good hygiene, and poor excreta management, to mention but a few factors,” Martelly said. “More than ever before, now is the time to address these deficiencies.”
As Haiti marks the second anniversary of the magnitude-7 earthquake that destroyed much of its capital, Port-au-Prince, cholera is at the top of a long list of significant health challenges that remain. NewsHour reporter/producer Larisa Epatko reported from Haiti this week that about 500,000 of the 1.5 million left homeless by the quake are still living in tent camps without reliable access to clean water and sanitation.
Public health experts say those conditions are hampering efforts to contain the cholera outbreak. Eighty percent of Haitians still have no access to proper toilets, and many drink and bathe in water near where they defecate. At the news conference, officials said there are 100 to 200 new cases of cholera each day. The Dominican Republic reports 21,000 cases and more than 300 deaths.
Cholera is a water-borne bacterial disease that spreads when contaminated water or food is ingested. People who fall ill can become rapidly dehydrated after developing severe watery diarrhea. Unless a person receives immediate medical treatment, death can occur quickly from shock.
The disease first emerged in Haiti 10 months after the quake and is believed to have been brought to the country by a team of U.N. Nepalese peacekeepers stationed in Mirebalais near the Meye River. In a paper released earlier this week in The America Journal of Tropical Medicine and Hygiene, researchers identified the first individual who likely contracted the disease: a 28-year-old mentally ill man who lived in Mirebalais.
Dr. Louise Ivers, one of the report’s authors and a senior health and policy adviser for Boston-based Partners In Health, says she and her colleague interviewed community leaders to see if they could learn any lessons about how the disease broke out. “This is such an obvious disease. It’s really not that difficult for people to remember the first person who became so unwell,” Ivers told the NewsHour. “People get very very severe diarrhea. It is an event that is notable in people’s memories.”
Ivers said the young man’s family had access to potable water, unlike many in his community. But because of his mental health problems, he often displayed bizarre behavior running around town naked and drinking from the local river. The man came down with diarrhea on Oct 12, 2010, and died within 24 hours. Two community members who washed his body fell ill 48 hours later. Within months, the disease had spread throughout the country.
Ivers and her colleagues are now working with the Ministry of Health in Haiti to implement a cholera vaccination pilot project. Some 100,000 doses of vaccine have been ordered and Ivers said officials hope to roll it out in several communities by late February or early March.
“There has been concern that by advocating for a vaccine you are trying to take resources away from water and sanitation improvements,” said Ivers. “But we believe it’s important to have complementary activities that lead us to the same goal. The very best thing that would happen is everyone would have potable water and a proper latrine. That investment is important, but it takes longer.”
During the early days of the outbreak, 10 percent of those who became ill with cholera died. Now, largely through community-outreach efforts to inform people when they should seek medical care, the death rate nationally is around 1 percent, although in certain parts of the country it remains high.
And public health officials are concerned the numbers of infected could dramatically increase, perhaps to as many as 1,000 new cases a day, when the rainy season starts in April.