Cholera is not "A Curse"
BY: ARTHUR M. FOURNIER (afournie@med.miami.edu)
BY: ARTHUR M. FOURNIER (afournie@med.miami.edu)
January 5, 2011, Wednesday
The universal response of colleagues when they heard of the cholera outbreak in Haiti was ``Oh, no! Not another curse on that country!''
With cholera, coming after political unrest and the earthquake, the theory that ``Haiti's cursed'' gained ground again. The truth, however, is that most of Haiti's curses, cholera included, are the consequences of the actions of men. Errors of omission and commission not just exacerbated the epidemic but also contributed to its cause and explosive spread.
The first cases were reported in small villages near the mouth of the Artibonite, Haiti's largest river, about 60 miles from Port-au-Prince -- a pastoral setting of small villages surrounded by irrigation canals and rice paddies. On Oct. 20, small clinics there reported being overwhelmed by about 50 patients with fever, vomiting and diarrhea. There were also reports of people found dead by the side of the road -- a macabre signal of just how quickly this disease could suck the life out of its victims.
By the second day, the public hospital in Saint Marc was overwhelmed, with more than 500 cases and more than 100 deaths. The next day, cases were also reported in Mirebalais, which sits on the Artibonite. Sanitation has long been neglected in the Artibonite, and the people routinely bathe and drink from the river. The outbreak occurred at the end of the rainy season, when the water table, at its crest, floods the makeshift latrines. All of this, however, begs the question: Why there?
The Haitians, of course, knew -- the reason was the Nepalese U.N. camp in Mirebalais. The United Nations denied it, in spite of the Associated Press reporting raw sewage dumped from the camp's latrines into a tributary of the Artibonite. Cholera is endemic to Nepal. When tests showed the strain causing the epidemic was endemic to ``South Asia,'' the U.N. countered that none of the soldiers they tested carried the strain. Recently, The Miami Herald reported that a French epidemiologist has strong evidence that cholera originated in the MINUSTAH camp.
The origin of the epidemic was important for two reasons. First, having already been stigmatized unjustly for HIV/AIDS, Haitians should not be blamed for cholera. More important, the U.N. should be held accountable. The Haitians knew all along the U.N. sites were dumping raw sewage into the river, and no one listened. The least the U.N. camps can do is to create adequate sanitation in their own areas. Better would be to make amends by pitching in, digging latrines and wells throughout the country.
Two caveats to this development:
• Cholera is not the fault of the Nepalese soldiers, but the result of a pervasive attitude among contractors that say ``Hey, it's Haiti! We can cut corners! No one will care!''
• We fund the U.N. and we need to hold its members accountable. Even if their camps are not the source, they shouldn't be dumping sewage into Haiti's rivers.
If humans cause Haiti's curses, they can also lift them. Sixteen years ago, Dr. Barth Green and I established a foundation to help Haiti called Project Medishare. Through the years it has grown to be an important contributor to Haiti's health.
You may have heard of Medishare's heroic work after the earthquake. You may not, however, have heard of our community-health project in the Central Plateau. Medishare's presence there, as well as its decade-long experience with community health, made it ideally suited to respond. We immediately deployed community health workers to the Artibonite. Armed with bullhorns and packets of oral-rehydration therapy, as well as donations of bleach and soap, our teams initiated a community education campaign, one small village at a time.
One of our tents used as a field hospital after the earthquake was set up in Mirebalais and, within a week of the outbreak, Medishare and Partners in Health opened a Cholera Treatment Center there. One month into the outbreak, we had already treated more than 2,500 patients, with only six deaths.
Other areas in Haiti, however, will not be so fortunate -- cholera will make 500,000 to 800,000 people ill and claim tens of thousands of lives; a curse not of divine, but of human, origin.
(Dr. Arthur M. Fournier is Associate Dean for Community Health Affairs at the University of Miami Miller School of Medicine and co-founder of Project Medishare.)
Source: The Miami Herald
