Sunday, April 1, 2012

The Story of Haiti's Cholera: No Silver Lining

Today's New York Times has a long report about the history of the introduction of cholera to Haiti following the earthquake. Introduction is the operative word there: despite all of the calamities that have befallen this most downtrodden of nations, cholera had spared the little half-island, despite outbreaks in nearby Latin America in the 1990s.

Cholera was absent before the earthquake, at any rate, and it ended quite likely with the arrival of Nepalese soldiers working for the United Nations. The short version is that it now appears that these soldiers unwittingly harbored the bacteria in their guts ("asymptomatic carriage" is common for diarrheal diseases like cholera and typhoid fever), and the bacteria was introduced to the water supply by inadequately-dug latrines leading to overflow into tributaries of the Artibonite, Haiti's principal river and the Haitian equivalent of what we think of as the municipal water supply--meaning the river in which hundreds of thousands of people bathe & wash.

After the bacteria took up residence in the guts of the locals, the outbreak was on, and since then 7,000 people have died, and we may be in for more as the rainy season begins anew. As we have noted before, this is a tragedy on a massive scale, and is getting scant play in the American news media, NYT and National Public Radio notwithstanding. The TV bigs must think that the quake makes for so much more exciting viewing. Maybe thousands of new graves in the coming months will change their minds.

The article does a good deal of post-hoc finger-pointing at the breakdowns in communication, coordination, and general inability to react quickly to the rapidly emerging threat of cholera in early 2011. I am a bit skeptical of its "if we had only done this" tone: there were so many moving parts, so many decisions that required coordination, so many barriers to organizational cross-talk that no single change would likely have prevented the outbreak. Which is not to say that there aren't important lessons to be learned, especially as we head into the rainy season, but it always seems so easy to identify problems through the retrospectoscope.

As the article details, now the level of trust between the Haitians and at least the UN is dismal. One local authority quoted in the article matter-of-factly discussed killing one of the soldiers--simply to make a political point. To describe this as "ominous" would understate the case significantly. And I'm dubious that such hostilities will be confined only to the UN personnel. If the bodies continue to pile up, the rage will spread like the cholera that came before it, with potentially equally lethal consequences.

1 comment:

  1. In support of positive solutions to the problem, consider following on facebook and twitter and supporting Sustainable Healthcare for Haiti as well as we have in our plans an outpatient clinic with solar powered refrigeration so we can be part of the developing Cholera Vaccine Supply Chain.