Those of you who have followed my blog for a while know that I worked in Haiti for almost two years after the earthquake in 2010. The first morning of the Cholera outbreak in the country I was on my way with a small group of experts to Arbonite to meet with some NGO officials relative to raising funds to build a trauma care Hospital in Port au Prince to replace the dilapidated hospital which had been destroyed in the earthquake. We were also working on the development of a waste processing facility for Port au Prince – as the city of over 3 million has no sewer plant or processing facility, and the open canals which carried sewage to the ocean seemed prime conspirators in the possible eventual emergence of Typhoid and Cholera.
When our little caravan got to the camp we were met by the National Chief of Police, who ordered us to turn back, explaining there had been a Cholera outbreak. This was shocking because the reason François Duvalier, the former Dictator of Haiti was loved by some of the populace and called ‘Papa Doc’ Duvalier, was his work leading to the elimination of 6 diseases from the country, including Cholera. There hadn’t been a case of Cholera in the country to this point in over 50 years, and the government and population believed it eradicated. He walked two of us around to the side of the camp, where we could see the makeshift hospital set up by DWB. They were carrying bodies out the back in a steady stream. He claimed that nearly 2,000 people had died the previous night. Cholera can kill a healthy person in under 12 hours from being infected if untreated.
Cholera is fairly simple to treat, if you have the right materials. Within 24 hours, the NGOs were attempting to fly in “Cholera Kits” – which consist of bags of saline solution to keep the patient hydrated, and an intravenous antibiotic to kill the disease. The disease kills by dehydration. The procedure has about an 85-90% cure rate – if the patient reaches care in time. It was obvious the folks we were supposed to meet were too busy treating the sick for us to meet, so we took the long drive back to the city, to try and help facilitate the logistics of getting the kits into Haiti.
The locals immediately claimed that the source of the disease as a United Nations Military camp upstream from the refugee camp, followed by a series of denials by the UN. It indeed turned out that the source of the disease was the UN Camp, and latrines dug at the shore of the river which leaked into the river. Further, contrary to UN Policy, the soldiers from Nepal had not undergone medical testing for the possibility of carrying the disease.
Once the disease got a start, it fairly rapidly spread, By the end of 2011, when I left the country the medical people were still trying to figure out how it was spreading to seemingly distant and disconnected communities. The lack of sanitation, and pure water certainly has operated to spread the disease, as it can infect thousands when even a single person with the disease comes into a city.
After the earthquake billions of dollars in aid were promised to Haiti. Most of that never materialized. The fault of that lies both in the Donor Organizations and Governments, as well as Haiti’s own politicians and Government.
The nation has been battling a cholera epidemic since 2010—and it’s still killing people. Why has no one been able to stop the spread of the disease?
In early February, when Jenniflore Abelard arrived at her parents’ house high in the hills of Port-au-Prince, Haiti, her father Johnson was home. (Some names have been changed to protect the privacy of patients and family members.) He was lying in the yard, under a tree, vomiting. When Jenniflore spoke to him, his responses, between retches, sounded strange: “nasal, like his voice was coming out of his nose.” He talked “like a zombie.” This is a powerful image to use in Haiti, where voodoo is practiced and where the supernatural doesn’t seem as far-fetched as it might elsewhere. Her father’s eyes were sunk back into his head. She was shocked, but she knew what this was, because she has lived through the past five years in Haiti. She has lived through the time of kolera.On October 18, 2010, Cuban medical brigades working in the areas around the town of Mirebalais (note: Mirebalais is located about 30 miles inland from PaP) in Haiti reported a worrying increase in patients with acute, watery diarrhea and vomiting. There had been 61 cases the previous week, and on October 18 alone there were 28 new admissions and two deaths.That was the beginning. Five years on, cholera has killed nearly 9,000 Haitians. More than 730,000 people have been infected. It is the worst outbreak of the disease, globally, in modern history. Hundreds of emergency and development workers have been working alongside the Haitian government for five years, trying to rid the country of cholera, and millions of dollars have been dispensed in the fight to eradicate it. But it’s still here. Why?
In 1884, the scientist Robert Koch sent a dispatch from Calcutta to the German Interior Ministry about the bacterium that he had been studying. It was “a little bent, like a comma,” he wrote. He was sure that this organism was causing the cholera that had been ravaging the world since 1817, when it laid waste to Bengal. Its onslaught there was shocking, even for a region that had had cholera—or something similar—for so long that there was a specific cholera goddess, Ola Beebee (translated as “our Lady of the Flux.”)
Ola Beebee was meant to protect against this mysterious affliction, which terrified people. Who would not be scared by seeing “the lips blue, the face haggard, the eyes hollow, the stomach sunk in, the limbs contracted and crumpled as if by fire?” Although 1817 is the official starting date of the first cholera pandemic, humans and cholera have almost certainly coexisted for far longer: That description of cholera’s distinct symptoms was inscribed on a temple in Gujarat, India, over 2,000 years ago.
The world is currently living through the seventh and longest cholera pandemic, which began in Indonesia in 1961 and, before Haiti, was most famous for an outbreak that devastated South America in 1991, killing 12,000 people in 21 countries.People with access to clean water and sanitation probably think of cholera as being as old-fashioned as smallpox, and long gone. Surely the problem now is Ebola? Away from headlines, though, the gram-negative, rod-shaped bacillusVibrio cholerae has been consistently murderous. It is currently present in 58 countries, infecting 3 to 5 million people a year and killing 100,000 to 120,000. This latest pandemic, wrote Edward T. Ryan of Harvard University, “as opposed to burning out after 5 to 20 years as all previous pandemics have done… seems to be picking up speed.”On February 11 this year, Johnson ate soup made from yams and bananas bought at the local market. By late afternoon, he was vomiting. With his soup he had swallowed Vibrio cholerae, which usually reach humans through contaminated food or water. Inside his body, the toxin secreted by the cholera bacteria bound to the cells in the wall of his small intestine, causing channels in the cells to stay open. Johnson’s disrupted cells flooded his gut with chloride ions. Sodium ions and water followed, causing his body to expel fluid and electrolytes and passing on more Vibrio bacteria to infect new hosts. A cholera victim can lose several liters of fluid within hours. Cholera can invade the body of a healthy person at daybreak and kill them by sundown.
Johnson is now safe and healthy in Jenniflore’s house, an hour away from his. He survived because he was taken to a nearby cholera-treatment center (CTC) run by Doctors Without Borders (DBW) and because cholera, despite its power, is easy to treat. Eighty percent of cholera cases are cured by the administration of a simple oral rehydration solution…(…more…)