ARTICLE - STRUGGLE TO CONTAIN CHOLERA

HAITI STRUGGLES TO CONTAIN CHOLERA OUTBREAK AS DISEASE CREEPS TOWARD CAPITAL
(The Toronto Star) - By Jennifer Wells

PORT-AU-PRINCE—The contradictions are inescapable.

Just as Haiti’s health officials prepared to present their update on the status of the country’s cholera epidemic Sunday – 253 dead, 3,015 hospitalized — a Jedco Services truck pulled up across the street to ream out the stinking port-a-potties that line the Champs de Mars displacement camp.

Champs de Mars remains a petri dish of seething, seeping unsanitary conditions. Are there wash stations by the toilets? No. How about dispensers of hand sanitizer? None that I could see. Do women use these in the middle of the night? I question whether they would feel safe. Is feces tossed into the gutter into the morning? Yes.

Hours after the government’s news conference, which addressed again the need for hand washing and careful attention to sanitation, I walked about the Champs de Mars and saw no evidence of outreach. What I did see was the same lineup of guys who, for 15 gourdes (about 30 cents), will peel back the pieces of carpet and bedding that protect the huge blocks of ice they’ve brought in from God knows where and chip off a chunk with their ice picks.

The kids will suck on a break-off piece as they carry the ice home to mom to melt for cooking.

Earlier in the day, on the other side of the road, Gabriel Thimothe, director of Haiti’s health ministry, and Claude Surena, president of the Haitian Medical Association, presented themselves before the local and international media and spoke of statistics (the vast majority of confirmed cases lie to the north of Port-au-Prince with, as we’ve said before, Grande Saline fingered as the epidemic’s birthplace).

“Stay calm,” said Thimothe. “It may stay for a time . . . The ministry has control of the situation.”

The ministry has control? Why does that not ring terribly true?

Perhaps because once again there’s that feeling of jack rabbit involvement by myriad health organizations and NGOs and, yet again, a lack of overarching co-ordination.

The Red Cross is organizing a cholera centre. UNICEF is involved in water treatment. The Haitian government, Surena said in an interview after the news conference, is “ready to install cholera facilities outside of Port-au-Prince.” As many as five are in the works.

The talk of the cholera cases in Port-au-Prince proper was verboten, as if a plague had been cast on ministry officials, who, at a guess, are terrified.

By Wednesday, Thursday at the latest, there should be a cholera isolation centre in Saint-Marc in the Artibonite region, where St. Nicolas Hospital has attempted to absorb the majority of sufferers who have sought help.

On Sunday officials stated that of the 3,015 cases confirmed, 2,774 came from Artibonite, north of the capital. St. Nicolas crashed under the weight of newly arrived patients. For a week, the ill and the healthy have intermingled with the hospital’s existing patients.

Late Sunday, UN deputy special representative Nigel Fisher said there were unconfirmed reports of cases in the city of Cap-Haïtien, on the island’s north coast.

“We must assume it will spread,” says Fisher. “We must be prepared for that.”

For all that, he raised a note of optimism. “It does seem the initial response has worked well,” he said in an interview Sunday evening, noting a decline in the death rate in percentage terms.

All eyes are on Port-au-Prince, where reports of five more unconfirmed cases bubbled — or tweeted — to the surface Sunday night.

Where this takes the country is into the great unknown.

David Sack, an eminent Johns Hopkins University cholera expert, probes the base science aspects of the outbreak. Has the source of the outbreak been traced to an estuary where a freshwater river meets a saltwater host, he wants to know.

“Cholera enjoys a little bit of salt,” says Sack on the phone from Baltimore.

Yes, as it happens, the waters where the Artibonite River meet the ocean at Grande Saline is the spot where many of the cholera patients interviewed by the Star said they had commenced their journey to seek medical help. More than 25,000 villagers have no access to latrines. “It likes to grow in brackish waters,” says Sack.

At Sunday’s news conference, reporters were told that the bodies of dead cholera victims had been dumped into the Artibonite in the Grande Saline area.

Still, the outcome is unknown and unpredictable. “There’s a lot we don’t understand about cholera,” Sack says. “In the past we’ve said the outbreaks will typically be over in a few weeks or a couple of months.”

Sack’s research has focused on Bangladesh, where the Ganges River (fresh water) meets the Bay of Bengal (salt).

“I have been in other camp situations in Bangladesh during the rainy season,” he says. “Basically you were walking in feces. Strangely enough, and I don’t know why, it didn’t develop into an epidemic.”

“But then there was Zimbabwe,” Sack continues. “It went on for a year. It was a horrible situation.”

What lies in store for Haiti?

“The big concern for Haiti,” says Sack, “is that once cholera is established it can persist in the environment basically forever.”

The shorter term outcome for Haiti is being measured case by case.