Haiti: Another disease of poverty in a traumatised land

October 30, 2010
Cite Soleil slum, Port au Prince, Haiti, 2008.

An outbreak of cholera has been documented in the area surrounding the lower Artibonite region of Haiti. There had been more than 2000 cases of acute watery diarrhea and 160 deaths reported by October 22.

Cholera is an acute diarrheal illness spread by drinking water containing the organism Vibrio cholera. Symptoms typically develop between one and five days after drinking water contaminated by the human feces of persons infected with the cholera bacteria.

Only about 10% of those who drink water contaminated by the cholera bacteria will fall ill. However, the infection can be fatal, particularly among young children, the elderly, the malnourished and persons with decreased immune function.

Those ill with cholera develop profuse, watery, high volume diarrhea that is rapidly dehydrating. Without adequate replacement of volume lost, patients may go into shock and die of dehydration.

Cholera is a disease of poverty — and was one of the earliest documented public health problems. Cholera epidemics are caused by a lack of access to safe, clean water.

Typically, the world’s poorest people obtain drinking water from a river or stream; in the absence of pit latrines or public sewage systems, the same river is used for defecation allowing human waste to mix with the water used for drinking.

Boiling water will kill the cholera bacteria, but the fuel to boil water costs money. As wood-based charcoal is the main source of cooking fuel in Haiti, use of charcoal is also related to the continued deforestation of the country.

Cholera can also be transmitted if a person eats food contaminated with the cholera bacterium.

Haiti has not had a documented case of cholera since the 1960s, the conditions in the lower Artibonite placed the region at high-risk for epidemics of cholera and other water-borne diseases even before the January 12 earthquake.

In 2008, Partners in Health (PIH), working with the Robert Kennedy Center for Human Rights, released a report of the denial of water security as a basic right in Haiti.

In 2000, a set of loans from the Inter-American Development Bank to the government of Haiti for water, sanitation and health were blocked for political reasons.

The city of St Marc (population 220,000) and region of the lower Artibonite (population 600,000) were among the areas slated for upgrading of the public water supply. This project was delayed more than a decade and has not yet been completed.

PIH believes secure and free access to clean water is a basic human right that should be delivered through the public sector. We believe the international community’s failure to assist the government of Haiti in developing a safe water supply has been in violation of this basic right.

As well, Gonaives, the capital of the Artibonite, suffered destruction in two waves of floods and mudslides after tropical storm Jeanne in 2004 and the series of hurricanes in 2008.

The extent of the devastation was made possible because of the environmental devastation of the region. The destruction contaminated the water supply and left the infrastructure (including health infrastructure) of the upper Artibonite in ruins.

This forced people to seek residence and medical care in St Marc. The St Marc region itself experienced significant flooding in 2008, displacing thousands of people.

Then the earthquake in January resulted in the displacement of 1.7 million Haitians. Reliable statistics are not currently available, but the last estimate in March was that 300,000 Haitians had fled the capital Port au Prince to the Artibonite.

As there are no “camps” in the region, these displaced persons are “home hosted” — joining poor relatives in already overcrowded conditions, without water security or adequate sanitation.

The dispersal of displaced people makes it difficult to provide centralised services.

Thousands of people are being given basic education, soap and oral rehydration salts in their communities by health workers. Those already ill are being referred to Zanmi Lasante/Ministry of Health facilities in the Artibonite and Central departments.

Programs of community mobilisation and mass messaging are being conducted by staff of Zanmi Lasante (ZL — a Haitian sister group to PIH) and local leaders. There is a sense from our team in the field that the outreach is working and patients are arriving at medical facilities at earlier, less severe stages of the disease.

Ill patients are being treated in facilities—most notably Saint Nicolas Hospital, where the ZL team is working in partnership with Doctors Without Borders (MSF)-Spain. In St Marc, MSF-Spain is setting up systems to separate cholera cases from non-cholera cases and to organise waste management and infection control.

On the national level, the leadership of PIH and ZL, with other partners, are working in the camps to help design the contingency plan for Port au Prince.

Yet the key to stopping the cholera epidemic in Haiti is to provide water security for the people of the Artibonite urgently and in the long term.

For the future of Haiti, we will continue to be engaged in community-based water projects as we have been for decades. However, community-based water projects and latrines will never be sufficient to assure the right to clean water — the government of Haiti must be enabled by international partners to assure this right.

To that end, we will also continue to advocate for money pledged for the reconstruction of Haiti be used to strengthen the public infrastructure of the country, including prioritising the development of a reliable and safe public water supply to provide real water security as a basic right for the people of Haiti.

[Abridged from PIH.org. Joia Mukherjee is the chief medical officer for the US-based Partners in Health, a grassroots solidarity-based organisation working in poor nations.]

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