DEATH AND DIRTY WATER: CHOLERA'S GRIM MARCH THROUGH HAITI
(Toronto Star) - By Jennifer Wells
DROUIN -At 6:15 on a weekday morning Lovely Avelus is not yet in her cherry red school attire, but rather the pale brown dress in which she slept.
An adolescent boy named Venecen — a shy recent addition to the family compound — carries her past the one-bunny rabbit cage to a semi-hidden patch of ground in order to provide some privacy for her morning toilet.
After a long, patient wait, Venecen tears a piece of frond from a plantain tree and hands it to Lovely so she may clean her bottom. Then off she scampers to continue playing peek-a-boo behind the curtain of her one-room home, which is dank and cold on this morning.
In the lone bed in this single room lies Lina, the 25-year-old daughter of Lovely’s uncle, Delius Elistin. Lina, who has a wet, rattling cough, gave birth to a baby boy two days before. She has not yet received any medical care.
It is simply too much.
Here in the land of earthquakes and here in the land of hurricanes and here in the land of abject poverty, Lovely’s family can now claim residence here in the land of cholera where, as of Friday, 330 have died and 4,714 cases have been confirmed.
Lovely’s extended family, none of whom has experienced an outbreak before, has some notion of what it means to play host to the latest disease to colonize Haiti. “We put two or three drops of bleach,” says Elistin, when asked what preventive treatments are applied to the water drawn from a nearby cistern. “We’re not putting much.”
Elistin says he has heard radio advisories recommending that the onset of diarrhea be treated by adding lemon juice to the water. It is true that lemon lowers the ph of water, thus making it an effective disinfectant against vibrio cholerae. If only it were so simple. “These days we cannot find lemons,” he says of his recent market searches. It’s hardly lemon weather.
Lovely’s mother, Rosemene, is cleaning out a small plastic container with a leaf. She is asked what special precautions she takes in preparing food, to which she responds that she washes the lettuce before consumption.
At Lovely’s home in Fermathe, at some remove from the squalor of the tent cities of Port-au-Prince, messages of prevention are half received and only partially executed. The U.S. Centers for Disease Control advises eight drops of bleach per gallon of water, which must be stored in clean, covered containers. Wash your hands after defecating is a steady reminder throughout the country. Lettuce? Verboten. “Boil it, cook it, peel it, or leave it,” is a simple CDC catchphrase which authorities here would do well to adopt.
It is as if the family lies in wait, just as the world lies in wait. Will the epidemic catch in the capital among the more than one million displaced in the fetid tent cities?
Cholera plays no obvious game. There are no stated rules.
It pops up one day in Drouin, and then Villard. And now there’s Petite Rivière and unconfirmed reports in Arcahaie. It is as if the epidemic were toying with the international and Haitian health communities, as if the bacteria too were playing a grim version of peek-a-boo.
It is unwise to think one has seen the worst of Haiti, or to imagine I had seen the worst of Haiti.
To observe the cholera outbreak in its full deathly flourish, one must travel to the Artibonite lowland, and so we chose the coastal route north from Port-au-Prince to Saint-Marc and from there northeast to Pont Sondé where the highway meets the Artibonite River. With luck, if the rains held, we would trace the river’s journey from Pont Sondé north again to Villard and then west to Drouin and on to Grande Saline where the Artibonite empties into the Gulf of Gonaives.
The coastal highway is often treacherous, not so much due to the state of the road, which is quite good, at least as far as Pont Sondé, but the quality of the driving. We observed four accidents on our way. The legless body of a trucker lies supine on the road, innards spilling outward, his head wrapped in a ragged bit of blue cloth, someone’s effort at a makeshift bandage.
At Pont Sondé it is market day and it is madness. Throngs of what must be thousands: farmers who have brought their haulage of sweet potatoes; women tending sacks of Haitian rice; split-open storage bags heaping with pyramids of rough salt brought from the coast. The fresh produce, agricultural bounty, is brought in by the tonnage and shipped out to larger cities: Gonaives to the north; Port-au-Prince to the south.
Across the span of the bridge, a serious line of women hustlers sells dry goods: ribbons and sparkly sandals and cosmetics. Below lies the river.
The river. The Artibonite is a historic irrigation artery for the country, albeit one that was dammed in the far east of the country by the U.S. in 1956, flooding part of the central plateau and displacing farmers there.
Here in the lowland — so rare in such a mountainous country — rice fields spread out square upon square, as if someone kicked a giant coil of sod and it rolled itself out to carpet the land.
The rains this season have been flooding and relentless. The area has been more or less under water since July, informs one aid worker. Women have come through deep water to get to market early.
The invasion of cheap, white American rice has economically devastated the rice farmers. Still, impoverished Haitian workers migrate here during the rice harvest, eager even for the 125 gourdes a day pay.
On Monday, as the death toll rose to 259 and the number of cases to 3,342, the United Nations Office for the Co-Ordination of Humanitarian Affairs echoed Haitian health ministry officials in citing cholera’s toll among the poorest of the poor. “Assessments show the majority of cases involve people from rural areas where rice growing is prevalent,” said the OCHA in a release.
Many deaths have been seasonal labourers. How ironic that doctors informing ill patients of the trademark characteristics of cholera describe the bacterial-ridden stool of victims as emerging “like rice water.”
Not all the victims are farm workers. Beyond Pont Sondé, just before the village of Villard, Maculèz Axelis dusts her aged feet though her small amount of un-hulled rice that she sells by the road. Her 14-year-old niece, Ti Madanm, died last night. She says the villagers have been asking that at least a clinic be built. If their requests had been heard, she says, the children would not have died. Simple rehydration salts often work wonders.
From the blacktop road at Villard, the journey turns to rougher stone and very quickly time evaporates. “Blanc!” cries a young boy outside a collection of the tin-roofed mud and straw huts that the rice farmers call home. That would be me, blanc. The outsider. Bonjour, blanc.
The villages spread either side of the Artibonite, which flows not more than 10 feet from the road. Great patches of drying rice trim the road: on one side the river, and on the other the rice.
Forty minutes later we arrive at the clinic at Drouin, serving the region of Grande Saline — with a population of about 45,000 — and the same named village that anchors it. The clinic was hit hard by the outbreak a week ago. “It was chaos. There were bodies everywhere,” says Dr. Rashid al Badi, who leads the clinical day shift.
Al Badi is wearing a red Humedica vest. The German aid agency is working in concert with a team of Cuban doctors. There are two tiny cholera victims hooked to IVs a few feet away. By midweek the clinic had recorded 40 deaths. I tell him I have heard that a patient passed away moments ago.
“He came alone,” al Badi says.
The patient was rehydrated. A single dose of the antibiotic Doxycycline was administered. “He was fully hydrated, we were trying really hard,” says al Badi. “Late morning he went into cardiac arrest.” Attempts at resuscitation failed.
He estimates the patient’s age at about 30, but who knows?
“The villagers didn’t recognize him.”
Perhaps he was a seasonal worker. “They are drinking water from the river directly,” al Badi informs. Of course they are. They have for centuries.
“Even after death we don’t know who to contact. We’re waiting for someone to come.”
On a narrow passageway between the clinic and a cement wall, the body of the unknown cholera victim has been placed. On this day, Wednesday, the death count will rise to 284.
The body has been covered with a blue tarp. Small thin pieces of wood have been placed on the edges of the tarp. The winds in the late afternoon can get quite spirited. I wonder if the wood will be blown away.
When the winds come up the rains cannot be far behind.
The village of Grande Saline cannot be reached, we are told. Access is flooded. Boats have been used to retrieve the ill. And a helicopter. And so, as they say in Creole, “nou fè bak.”
In doing so we trace the journey of the stricken seeking medical care to the road back to Villard where it meets the highway, returning via Saint-Marc and on to Port-au-Prince.
It’s a mistake to become oblivious to the noise and chaos and horn blaring. The Toyota pickup on our tail appeared to be any other impatient Haitian, the words “Merci Jesus” painted on the front of his truck. He was in a great hurry. Isn’t everyone? Until I noted a hand holding an IV bag rising from the back of the truck, and let the truck pass and studied the despairing look of a young man keeping the arm of a limp old man aloft, the old man’s lean form spread across two laps in the back of the pickup.
The truck pulled up to Saint Nicolas Hospital in Saint-Marc. Earlier in the day I had revisited the clinic, my third trip in. By Wednesday at the latest a cholera treatment centre was supposed to be in place, taking the victims out of the general hospital population.
“But they had to stop construction because people didn’t want them to build this centre near their homes,” says Dr. Mayette Yfto, the hospital’s chief administrator. He’s very polite, Dr. Yfto. The locals threatened to burn the thing down.
Instead the centre will be constructed in Pont Sondé.
The good news: the number of admissions at Saint Nicolas has slowed, says Patrick Almazor, the Partners in Health director for the Artibonite region. PIH has had a long-term working alliance at Saint Nicolas and its doctors and nurses have been key to handling the crisis. Sixty-five deaths have been recorded at the hospital. More than half of those victims died before being carried through the hospital gate.
On Tuesday, Almazor saw a body on the road to Petite Rivière. “After three or four days they dump them into the river,” he says. The nameless ones.
From Saint-Marc the medical geography of Haiti’s cholera epidemic splits in two.
On Thursday, there were reports of 174 cases further south along the coastal highway at Arcahaie. The name may mean little today but there was a time when the beach strip from, roughly, Montrouis to Arcahaie featured a Club Med and other Caribbean-style getaways and there was a time when a cholera epidemic in Haiti would have been measured in lost dollars in tourism and trade.
No more. The local news reports the small street vendors are suffering some.
On the northern side of the mountains that split the lowlands from the coast, cases have been reported at Verettes and Mirebalais.
For more than a week the mayor of Mirebalais has blamed the deaths in his community on a Nepalese-staffed United Nations base situated on the Meille River, a tributary of the Artibonite.
The UN has repeatedly insisted that none of the 700 on base has tested positive for cholera and that suggestions in some media reports that uncontained excrement has leeched from latrines are not true. The seepage, says UN spokesperson Vincenzo Pugliese, can be sourced to overflowing “soak pits” containing shower and kitchen waters.
“For sure it’s about migration. For sure,” says Mayette Yfto, meaning that the epidemic has been imported from lands abroad. It is as if Haiti is desperate to prove that this one horror, this one catastrophe, is not of its own making.
There may never be an absolute answer. Even genetic markers may ultimately fail to prove the epidemic’s source.
In a news conference Friday, Gabriel Timothee, director general of the ministry of health, said “patient zero” had yet to be identified. Eight deaths have been recorded in the Artibonite since Thursday.
As the media drifted away, Michel Thieren, head of the Pan American Health Organization in Haiti, offered the simplest assessment. “This is an epidemic that will settle over months,” he said gently.
What is clear is that cholera is now an endemic part of Lovely’s Haiti. And that the Artibonite River has proved a welcoming host.