ARTICLE - LESSONS FROM BANGLADESH

INTERVIEW: LESSONS FROM BANGLADESH FOR HAITI'S CHOLERA EPIDEMIC
(Monsters and Critics.com) - By Anindita Ramaswamy

WASHINGTON - Bangladeshi doctor Pradip K Bardhan knows how easy it is to treat cholera.
His hospital in Dhaka sees nearly 140,000 cholera patients each year, with a near-zero fatality rate.

The World Health Organization (WHO) estimates an annual burden of 3-5 million cholera cases and 100,000-120,000 deaths. While the disease can kill within hours if left untreated, no one needs to die from cholera. A simple sugar-and-salt solution can revive even the severely dehydrated.

In Bangladesh, women have learnt that a sari folded four to five times can be used to filter out cholera-causing bacteria from drinking water.

But things are infinitely more complicated in Haiti, where Bardhan has spent close to three weeks at the request of WHO and where the cholera death toll has crossed 1,250.

This is, after all, a country struggling to recover from an earthquake in January that killed 230,000 people and left more than 1.5 million homeless.

There was no respite after Hurricane Tomas as a cholera outbreak emerged and swiftly spread to Port-au-Prince, the capital city of tattered, overcrowded tents, rubble and open sewers.

Cholera, a disease of poverty contracted through contaminated water that causes severe diarrhoea and vomiting, is also a disease that this current generation of Haitians has never encountered, and one that the county's collapsed health system can barely cope with.

'The people here are absolutely unaccustomed and unprepared to tackle cholera cases. In Haiti they have not seen cholera cases for maybe a century. They do not have any immunity - it's like a virgin population as far as cholera is concerned,' Bardhan told the German Press Agency dpa by telephone from Port-au-Prince.

'The strain ... seems to be quite virulent. So the disease is likely to have a severe course,' and a much higher proportion of people will fall sick or die than in countries such as Bangladesh and Pakistan where the population has exposure to cholera.

Conditions were ripe for a cholera epidemic even before the earthquake because of Haiti's unsafe water supply system, which was further weakened by a series of hurricanes, floods and mudslides.

Bardhan's experience in treating cholera across continents tells him the disease has come to stay in Haiti for several years.

'The reason cholera is not going away soon is that the two things you need to control it are safe water and good sanitation, which are really not here,' said Bardhan, of the International Centre for Diarrhoeal Disease Research.

'It's quite likely that the cholera germ has taken a foothold in the river system. It will not be easy to get out of it unless they make a marked improvement in supplying safe water and providing good sanitation to the whole population - and that's a tall order.

' Cholera prevention also involves behavioural change, such as good personal hygiene and hand washing, he said, which will take time to inculcate.

Bardhan and his nine-member team have been training Haitian doctors how to confidently manage an unfamiliar disease.

'Their fears are (largely) about transmission, how safe is it if you have cholera in your neighbourhood, how do you dispose of a body, is it safe to touch a cholera patient,' he said.

Some Haitians have blamed the epidemic on UN troops from Nepal. The US Centres for Disease Control and Prevention said the cholera strain linked to the Haiti outbreak is 'most similar' to strains found in South Asia. It cautioned that more work was needed to determine the origin of the strain.

The fact is that 'it has been introduced. I don't think it's possible for anybody to pinpoint blame,' Bardhan said. 'Even if the strain is from South Asia it does not mean that the South Asians have brought it. It could be from somebody who visited South Asia and then came here.'

Cholera first spread across the world during the 19th century, from its original reservoir in India's Ganges delta. Six subsequent pandemics killed millions of people across all continents. The current, seventh, pandemic started in South Asia in 1961, reached Africa in 1971 and the Americas in 1991.

'Cholera warrior' Bardhan is used to fighting the disease in difficult places such as Zimbabwe and Pakistan after this year's floods. In Haiti, he's seen pessimism and fear, but also the determination to overcome the worst.

'I think every Haitian believes that given a chance and some assistance, they'll be able to recover from anything,' Bardhan said.