Cholera arrived in Haiti this month with a vengeance. Since the first case was identified on October 19, 4,764 people have been hospitalized and 337 deaths have been counted.
The actual numbers may be much higher; early in the epidemic, over half the people counted as deceased arrived at health centers already dead, indicating that many were dying without accessing services. The outbreak is centered in the rural Artibonite and Central Plateau regions, where health centers are few and far between and transportation to the centers can take hours.
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In the rural village of Delande, numerous residents reported deaths in their families. There are no toilets in Delande, and locals have historically bathed in and drunk the river water. When the disease hit, the basic sanitary conditions necessary to control cholera were simply not in place.
Early on, people died and were buried at home. "There are many who haven't had time to go to the hospital and died," said local pastor Solomon Thomas. No government or NGO workers have come to the village, so it is almost certain those deaths were not counted. Now the community is scared and taking the sick to the hospital--a process that requires carrying the ill across the Artibonite River and over a small mountain, then finding a motorcycle or car.
Hand washing as a last resort
"The solution to the sickness is in your hands," said Haitian president Rene Preval at a meeting with leaders of affected areas last Sunday. The gathering was labeled a disaster response meeting, but in reality it was a three-hour public health lesson. The attendees learned that cholera is a bacterial infection. Because it causes extreme diarrhea and vomiting, the disease evacuates the body of almost all its water and leads to severe dehydration that can kill within hours.
The leaders also learned that cholera is easily preventable through proper sanitation and health practices. It is not spread from person to person; one has to ingest the bacteria through contaminated water or food.
During the meeting, Preval called upon leaders one by one to "test" them on what cholera is and how it can be prevented and treated. Guerrier Fisnal, a public administrator for the commune of Crete-Brulée, admitted he "learned a lot from the discussion." He can now share the news with his community that people need to wash their hands and boil drinking water.
Public health messages have also been disseminated on the radio, in the newspaper, and via informational text messages sent by Voila and Digicel, Haiti's two major cell phone companies. But the issue goes deeper than individual hygiene. In a country where, according to UNICEF, less than forty percent of the population has access to latrines and potable water is scarce, many are forced into daily contact with contaminated water.
Gabriel Timothee, director general of the public health, ministry acknowledged, when probed, that a better sanitation system would have lessened the impact of the disease. "But in any case," he continued, "it's a sickness of dirty hands." In the areas without toilets, where feces run in the open sewers, he suggested that people wash their hands more frequently.
As the crisis continues, the government and international institutions are distributing Clorox as widely as possible. And their efforts have diminished the number of new cases and deaths. But in Haiti, cholera is here to stay. Even if the epidemic can be contained in the near term, infected bodies buried without being sanitized will contaminate ground water. This can "bring back the malady at any time, even in five or six years," warned Alex Larsen, the minister of health.