ARTICLE - CHOLERA IN HAITI'S HISTORY

CHOLERA IN HAITI'S HISTORY

The FHI Haiti Lab at Duke has been engaged with deciphering Haiti's earlier history with cholera.

BY DEBORAH JENSON

The arrival of cholera in Haiti is first and foremost a health emergency.

Once the emergency is over, though, the stigma attached to the disease will likely linger, only prolonging the suffering of a country that can hardly afford any more agony.

It's happened in Haiti before. In the 1980s HIV crisis, Haiti and its people were falsely associated with the disease and risky behavior. This stunted economic growth, handicapped freedom of movement and disfigured Haiti's public profile. In many ways, the stigma rivaled the spread of disease.

The conversation changed only after humanitarians like Paul Farmer worked with Haitian communities to develop effective treatment and prevention strategies which have become a model for global health.

Cholera can yield a similar blow to Haiti on the world stage, even though Haiti is one of the few Western countries which until now had escaped cholera's path. One way to mute this devastating association is for the world community to respond in a bold, broad and coordinated manner to the outbreak.

Cholera has long been a menacing scourge. Karl Marx has called it India's revenge on Western colonialism. The disease stimulated the development - through painful necessity - of engineering solutions to sanitation problems in Europe.

When it first arrived in the Americas in 1832, Haitian President Jean-Pierre Boyer immediately announced public health measures to prevent "the invasion of cholera morbus in Haiti, which has already traversed Europe, and penetrated the United States."

Research of 19th century newspapers reveals that while cholera raged in the U.S. and much of the Caribbean, it failed to take root in Haiti, the world's only nation born of a successful revolution against slavery. Occasional rumors that cholera had arrived in Haiti were denied by international diplomats and traders.

In the mid-19th century, Haitian historian Thomas Madiou noted, "It must be observed that cholera has never entered Haiti, even when it raged all around our island, in St. Thomas, Puerto Rico, Jamaica, and Cuba, in the Lesser Antilles and the Greater Antilles alike. Could this be due to some emanations of our soil that don't allow choleric toxins to survive, or to some condition of our atmosphere?"

Even Haiti critic Spenser St. John would write, in 1886, "Although Port-au-Prince is the most disgusting city I have ever seen, it has never been visited by cholera."

President Florvil Hippolyte in 1892 again published protocols to prevent the introduction of a Euro-American cholera infection, and there is no record of epidemic cholera in 20th century Haiti (and little cholera activity anywhere in the 20th century Caribbean). It strongly appears that Haiti has never before been ravaged by cholera.

That, of course, is no longer the case. Climate change, and flooding like that which immediately preceded the emergence of cholera in the Artibonite region of Haiti in October, have now facilitated transmission of cholera to one of the last unaffected countries in the Western world.

Tragically, the deployment of troops from cholera-endemic regions in the UN's "Mission to Stabilize Haiti" may be responsible for the introduction of cholera into the flooded river system, making international humanitarian and policing initiatives a vector of both the disease and the cure.

Only a small percentage of those who come down with cholera will become mortally ill, and most of them can be saved with antibiotics and rehydration. And we may be seeing in regions like St. Marc, where the death rate is dropping markedly, that the disease has mostly run its course.

But other emergencies are popping up in many communities, including in Port-au-Prince, where the presence of large numbers of people in camps creates a particularly dangerous situation.

A swift response on the part of health care providers, combined with timely identification of outbreaks, public health information campaigns and "swarm response" to affected areas, will help Haiti surmount its time of cholera. Will it survive the stigma, too?