Latin America in the time of cholera


By Mary Judith Ress

SANTIAGO, Chile — As many as one in four Latin Americans — 90 to 120 million people — could come down with cholera in the coming months, according to estimates by the World Health Organisation.

The disease has reached epidemic proportions in Peru and has spread to Ecuador, Colombia, Brazil and Chile. WHO estimates that within the next two months cases will also appear in Bolivia, Argentina and Uruguay. The UN agency is now warning of a possible "pandemic".

Cholera is spread by water, milk or other foods contaminated by the excrement of cholera victims. The disease is usually present in warmer climates, since cold weather inhibits the growth of the bacteria. Cholera epidemics are generally caused by contamination of the water supply.

"We've never been able to determine why, but every once in a while, this bacteria goes travelling to other parts of the world", says Myron Levine, a US infectious disease specialist currently in Chile. "But the major problem is not the appearance of the bacteria, but how to control its spreading."

According to WHO director Hiroshi Nakajima, millions of Latin Americans living in the "misery belts" surrounding the regions's urban centres, and the rural poor, are the highest risk groups. WHO registered 177,000 new cases of cholera in the first four months of 1991, 2000 of which have been fatal.

The organisation recently set up a special "crisis cell" made up of 10 international experts in epidemiology to combat the spread of cholera. Special emphasis will be given to education and containment of the pandemic, according to Dr Jim Tullock, who heads the cell. WHO estimates that $5 billion will be needed to eradicate the disease in the region.

Cholera broke out in Peru in early January. Today, WHO estimates that as many as 75% of the 22 million Peruvians could be infected with the bacteria, even though they show no symptoms. Currently more than 150,000 cases have been detected in Peru, and 1140 of these have been fatal.

Local health officials agree that because of Peru's poor sanitary conditions, it will be a long time before cholera is eradicated there. The number of cases reported in Lima has decreased with the arrival of colder weather, but in the Amazon

jungle region the number of victims continues to rise.

The Amazon River and its tributaries appear to be the major transmitter of cholera to Ecuador, Colombia and Brazil. After Peru, Ecuador has the highest number of cases. Health officials are reporting 3500 cases, but the actual number is closer to 5000, of which 80 have been fatal. Colombia reports 174 cases with five deaths. Local officials trace the first cases to the jungle region bordering Peru and to Pacific ports next to Ecuador.

Conditions in the Brazilian jungle states of Acre, Rondonia and Amazonas are extremely underdeveloped. Health officials are especially concerned about indigenous peoples living in the area. The Brazilian daily O Globo reports that the 25,000-member Ticuna tribe living along the Solimoes River bordering Brazil, Peru and Colombia could be devastated by cholera because of the tremendous poverty and neglect in which they live.

Chileans have been caught off guard by the arrival of cholera in Santiago rather than in the northern region bordering Peru. So far, 31 cases have been reported, with one death. The bacteria is now in the capital's water system, which receives tons of raw sewage daily. Cholera's arrival has underlined the need to build a long-postponed water purification system here.

Argentina is also bracing for a major cholera outbreak. Local epidemiologists warn that the disease will unmask the country's deteriorating health and sanitation system and show the extent of poverty racking the country, especially in the shanty towns surrounding Buenos Aires, where some 6 million Argentines live.

Although it has not yet reported any cases, Bolivia is believed to be "fertile ground" for the spread of cholera. WHO experts say that this country of 6 million could provide a "worst-case scenario" because of an almost total lack of sanitation and hygiene. Raw sewage runs through irrigation canals and in the streets in both cities and rural areas. Garbage is simply dumped in parks and marketplaces.

Cholera is expected also to appear shortly in Uruguay and Paraguay.

The epidemic has also taken its toll on the region's small farmers, fishers and restaurant owners, whose livelihood is based on the daily sale of fresh vegetables and fish. They have witnessed a dramatic drop in business as a result of government warnings to stay away from contaminated food.

"People are interpreting the campaign not to eat raw fish or fresh vegetables as a warning not to eat them at all", complained a fish vendor at one of Chile's open-air markets. "The government should concentrate of urging people to cook their food, instead of not eating it."

Chileans grimly remember that two years ago the discovery of two grapes supposedly poisoned with cyanide cost exporters some $400,000 in revenues. The fallout from "cholera-contaminated" produce could bring even more disastrous results.
[From the US Guardian.]

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