The State of Cholera, and Water, in Haiti

By William Wheeler

This post is part of a special National Geographic News series on global water issues.

Photograph by William Wheeler

The orderlies’ urgent shuffling broke the grim quiet of the cholera treatment center in Mirebelais, near the origin of the outbreak, as they rushed seventy-year-old Clercius Vileus in on a stretcher. A subsistence farmer, Vileus draws his water from a well near the Artibonite River. He knew it might be tainted, said the young man who brought him in, but it was the only water they had to drink. Vileus grew sick. But he was accustomed to stomach bugs, so he waited a day before coming into town for help. His eyes had an intense, otherworldly glow. When Dr. Wesler Lambert reached out and pinch the skin on his thin stomach, it remained puckered into a wrinkly fold: he was severely dehydrated. Without help, the doctor said, Vileus would probably be  dead within hours.

This was in late November and we were a few hours drive from Port-au-Prince, where the spreading epidemic had added fuel to the fires of civil unrest then erupting. In the weeks ahead, a presidential election marred by widespread fraud would touch off more protests and riots that would shut down the city, which would prevent the clinics in the countryside from getting more supplies of IV fluid and antibiotics, which would later trigger a rush on supplies and new shortages in the capital when the protests ended.

(See more photos.)

At the time, the official death toll was around 1,000 people with more than estimated 20,000 infections. Health officials had tentatively announced the situation might be stabilizing. But that was misleading. Dr Lambert thought the numbers were low and would likely rise, because the assessment overlooked all those who never even made it to a clinic, and also because cholera appeared in cycles– plateaus followed by spikes, plateaus then more spikes – which would be the trend for months. Humanitarian agencies were rushing to expand their operations around the country—a job they later received a lot of credit for. They were asking for donations of supplies and money, trying to distribute chlorine and water purification tablets, and broadcasting instruction that cholera could be prevented by washing hands thoroughly and boiling water. The organization that Lambert works for, Partners in Health, joined Doctors Without Borders in criticizing a slow initial response from the humanitarians.

It was, he said, a case of too little, too late.

Today, the disease has affected more than 250,000 people and the official toll includes over 4,600 dead.

That sentiment was reflected in a study by American researchers, published earlier this year in the medical journal The Lancet, which concluded that UN projections on the epidemic were too low because they failed to account for cholera transmission rates and trends, and various intervention measures have been debated without comparative estimates of their impact.

Consequently, the cholera epidemic is much bigger and likely to be much longer lasting than initially expected. Using mathematical models, the study predicts there could be nearly 800,000 cholera infections and 11, 100 deaths between March and November of this year. That’s nearly twice the estimate that the United Nations had put forward. They also concluded that recent decline in cases is a normal ebb and flow of the disease, not “indicative of successful intervention.”

But the study predicted that a gradual improvement in access to clean water, along with distributing more antibiotics and vaccinating 10 percent of the population, could prevent some 3,700 more deaths.

(Read more about how Cholera and Cooperation Play Into Haiti Reforestation.”)

The question of how cholera came to Haiti is still up for debate. Many Haitians blame leaking pipes from a septic tank on a UN base near along the Artibonite River, just upstream from Mirebelais. The UN spokesman told me that an investigation had turned up no trace of cholera at the site, but that the link could not be conclusively proved or disproved.  But there was plenty of circumstantial evidence. When I visited the base, which is inhabited by peacekeepers from Nepal, a major said he wasn’t authoried to speak on the matter. Around the back of the base, there was a strong chemical odor beneath the pipes  at the bank of the Artibonite. My driver said that, a few weeks before, there was a filthy stream running from the pipes into the water. Yves German, who owns the land the base is on, told me he had seen pigs rooting around in the muck there two years ago and had complained ot the local mayor. People had been getting sick periodically for years, he said. But the first cases appeared downstream only days after a new contingent of peacekeepers arrived. The Center for Disease Control in Atlanta found that the strain is endemic in South Asia.

Regardless of its origin, Dr. Lambert said that the spread of the disease reflected a long history of neglect: it’s the result of the government’s failure to develop health and sanitation infrastructure, but also the gaps of an international relief effort that told people not to drink from the river without providing a realistic alternative. “One of the problems with NGOs is sometimes they like to work in an enabling environment where they have everything,” he said. “But the reality is different.” Just as the earthquake had exposed how little had been done to develop basic water and sanitation infrastructure in Haiti, especially outside the capital, the spread of cholera reflected the limits of relief efforts concentrated mostly in quake-impacted areas in Port-au-Prince.

“It’s a common failure,” he said. “It’s my failure because I’m Haitian. I do as much as I can from a healthcare perspective. But it’s [also] a failure of the international community. Since 1991, even since Jean Claude Duvalier, we have received billions from the international community. Look!” He wanted to know how the US and Canada could tolerate such a situation in Haiti, just “one and a half hours from Miami,” he said. “We’re the only country living in such conditions in the Caribbean.

William Wheeler’s reporting in Haiti was supported by a grant from the Pulitzer Center on Crisis Reporting.


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