PORT-AU-PRINCE -- Last Tuesday, Fritz Hauteau started to feel very ill. He had diarrhea; he was vomiting; he was feeling weaker and weaker. "Everything hurt," he said, "I was so sick to my stomach and my whole body hurt." Neighbors in his tent city in the Delmas section of the capital called Hauteau's brother, who hailed a motorcycle taxi and took Fritz to the General Hospital in Port-au-Prince, where a "diarrhea treatment center" had been installed after the current cholera epidemic was discovered in Haiti last month.
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Early in the epidemic, Haitians and journalists alike were frustrated by the government's refusal to acknowledge the scope of the problem. Repeatedly people with telltale cholera symptoms: "rice water diarrhea," excessive vomiting of any remaining traces of water, and serious dehydration, were said to need "laboratory confirmation" before being added to the official tally.
As Francois Servranckx, communications advisor for Medecins sans Frontieres (MSF, Doctors Without Borders), explains: "In general in an epidemic whether its cholera or meningitis, at first we try to confirm through laboratory testing the presence of the bacteria in a certain number of cases. But once its presence is confirmed we don't do tests on each person; we do clinical diagnostics."
Cholera has migrated south from the rural Artibonite region and, as anticipated, has infiltrated the quake-ravaged capital. The diarrhea treatment center at the general hospital here is now overwhelmed with unambiguous cases of the disease. "We had people all over the floor," says Dr. Yves Lambert, director of the center. "We had to call tap-taps [the public transport vehicle in Haiti where benches line the back of a pick up] to take them to other centers."
When I met Fritz Hauteau at the diarrhea treatment center, he was sleeping, dehydrated, shrunken, and weak, curled on a cot in a corner of the room. Hauteau was one of the 18,383 Haitians hospitalized for cholera in the past month, and luckily not one of the more than 1,100 counted dead.
By the time he was released from the hospital, Hauteau's tent had been battered by heavy rains from Hurricane Tomas and was now contaminated. "It was completely soiled and not safe, so I threw it away," his brother explained. Meanwhile, evictions of "squatters" has continued as land owners grow tired of seemingly permanent campers who set up on their properties after the earthquake ten months ago. "The owner doesn't want people there, so he won't let me come back," Hauteau explained.
I asked a contact at one of the international NGOs set up in Port-au-Prince what someone in need of a tent should do. The response: "Delmas 18--I don't think we work there. Ask him who the camp manager is, and let me know how it goes." Hauteau said there was no camp manager, even though 60 people were living on the property.
So can the NGO's help directly? "NGOs do give things out, but not everyone finds it," explained Hauteau's brother, "they give it to their own people." And the government? "There is no government," said Hauteau. So what are you going to do? He shrugged, "I don't know."
The Human Element
Haiti is colloquially known as the "Republic of NGOs." Over 10,000 organizations work in the country. In fact, Haiti has the second highest number of NGOs per capita in the world after India.
These organizations are now scrambling to hand out water purification tablets, but every NGO has a differently defined segment of the population that they aim to work with: women, people living with HIV, children, this camp or that, this area of this slum, that village, this school, that orphanage. No one can replace the government, of course, and many NGOs struggle to coordinate with the highly bureaucratic and often inefficient state institutions. Some actively renounce coordination with the state, because they find it too corrupt and inhibiting.
The government is meanwhile strapped for cash, despite an ostensible influx of aid. Less than 38 percent of the aid pledged to Haiti at a post-quake donors conference in March has been disbursed. Most of it has gone to these NGOs, rather than the state. The tax system is broken, and most Haitians work in the informal sector, off the government's already weak radar. Investing in Haiti can take six months of bureaucratic tangles, limiting business growth and the income it brings.
Hanz Legagneur, director of the ministry of public health for the West department (which includes Port-au-Prince) outlined for me the number of cholera deaths and cases in several of the cities. I asked him how many were in the capital and he gave me the number in MSF centers. But when I asked for numbers from the General Hospital, he said, "I don't have those numbers, those are under the direction of the University." MSF set up that treatment center, but they are no longer controlling it, and don't list it as one of their centers. So who knows? No one.
Medically, cholera is easy to prevent and treat. But in Haiti, it is proving impossible to control. What Haiti needs to combat cholera is a functioning water and sewage system. But no one--neither the water-and-sanitation "cluster" of organizations, nor UNICEF, nor DINEPA, the Haitian water and sanitation authority--has accomplished this.
So Haitians like Hauteau and his brother share a single public toilet with the other families on their block and find water any way they can. Hauteau's brother buys buckets of untreated water from a private company that brings a water truck through his neighborhood and adds chlorine. Hauteau said he sometimes buys bottled water, but couldn't afford to everyday, so he drank tap water--which gave him cholera.
Haiti's cholera outbreak is now a full-fledged humanitarian disaster, but at heart it is a management issue. If NGOs want to commit to an effective course of action and help end this epidemic, they will have to focus and coordinate their efforts rapidly and rigorously on the basic conditions that are sustaining it.