ARTICLE - SOAP SCRAMBLE

AMID CHOLERA OUTBREAK IN HAITI, A SCRAMBLE TO GET SOAP
(Washington Post) - By William Booth

PORT AU PRINCE - The difference between life and death in Haiti is now an ordinary bar of soap.

Soap could slow the terrifying cholera outbreak that is quickly spreading and has just in the past week entered the ravaged capital, according to health care specialists and international aid groups.

But in the squalid slums of Port au Prince and the river towns where the cholera outbreak began three weeks ago, many Haitians held up their hands and shook their heads, saying they had no soap to stop an infection that is spread by contaminated food and water, and where a vigorous hand-washing, especially after using the toilet, is the number-one way to save lives.

A cake of yellow Haitian soap costs about 50 cents. But many Haitians do not have soap, because they cannot it afford it. More than half of the population lives on less than $1.25 a day.

"They buy food instead," said Gaelle Fohr, a coordinator for hygiene programs in Haiti for the U.N. Children's Fund.

"We borrow, we buy, but right now, we don't have any soap in the house, I am sorry to say," said Joceline Jeune, living with three children in a hillside shanty at the edge of a displaced persons camp, as a gutter filled with greasy gray water flowed inches from her front door.

When confronted by dubious toilets or flyspecked markets, people here daily use the expression, "mikwob pa touye ayisyen," which translates "germs don't kill Haitians."

"As hard as it is to believe, Haiti still needs soap. They have many needs, but soap - and access to clean water - is absolutely essential to fight cholera," said Nigel Fisher, the top U.N. humanitarian coordinator, in an interview.

There are plans for more water trucks, and more chlorine in water tanks, wells, and distribution points. But building a modern water and sanitation system will take years. By contrast, experts say, soap is fast and doable, allowing people to clean their hands and food that has been exposed to dirty cholera-tainted water.

Foreign governments, international aid groups and individuals have sent more than $3.4 billion in humanitarian aid here in the 10 months since a tremendous 7.0 earthquake struck the capital, killing about 300,000 people and displacing more than 1.5 million, according to the Haitian government. But poverty is so deep, needs can seem bottomless.

"Haiti has crowded slums, poor hygiene, incredible poverty - before and after the earthquake.

This is an extremely contagious, extremely virulent strain. It can kill in a few hours - unless you get help. We have well over a million people in camps, we have a disease that spreads by hand, mouth, touch, water. It can lie dormant for five days. You cannot tell who is infected," said Fisher. "The country is now facing a tremendous challenge with limited resources."

Experts at the Pan American Health Organization forecast 200,000 Haitians will show signs of the disease, while it is possible a million will be infected, but remain asymptomatic carriers still capable of spreading the potentially deadly bacteria.

The Haitian health ministry reported Sunday there have been 917 deaths and 14,600 people hospitalized since the cholera outbreak was confirmed three weeks ago. The complete tally is certainly higher as the government is counting only people who make it to clinics.

"For the people who live in the hills, it is a two-hour walk to the road, where they can catch a tap-tap," a Haitian bus, "and some of them have already been sick for two or three days, and they have to be carried to that road," said Heather Lorenzen of the group International Medical Corps as she was erecting tents to serve as a cholera treatment center in Gonaives in the Artibonite valley.

Across the street, workers in yellow gloves and protective masks were scouring the floors and walls of the main hospital that had been overwhelmed by cholera patients and their symptoms.

The illness can produce prodigious diarrhea and vomiting, and patients die not of the toxin the cholera bacteria produces, but of dehydration. The hospital had become so contaminated by cholera that it was closed to new patients on Saturday for fear that they would enter to give birth to their babies only to leave infected with cholera.

Minoushe Picot, about to deliver her baby any day, said her neighbors in Gonaives were at first terrified of cholera, as rumors swirled that it was another sign of the coming apocalypse. "But now we know that not everyone who goes to the hospital dies. Now we know we can beat it," she said.

In the last two weeks international aid groups have been scrambling to deliver soap and hygiene kits to the some of the million people stilling living in tarp and tent camps in the capital and to the most vulnerable populations in the countryside.

UNICEF brought 100,000 pieces of soap in 500 of the country's orphanages. Along the Artibonite River valley, the group distributed 82,000 bars. They will be heading into 5,000 schools in coming weeks.

The group called Clean the World has distributed 100,000 bars of used soap it collects from 550 hotels in North America and recycles - instead of allowing the bars to be thrown away after one use by a guest. They promise 200,000 more soaps by the end of the month.

But shortages abound - not only of soap, but also of bleach, intravenous fluids, powdered rehydration solutions, and doctors and nurses trained in cholera. Haiti has not had a cholera outbreak in more than 50 years.

Louise Ivers of the medical group called Partners in Health said a survey found that 521 of the 1,300 camps around Port au Prince did not have any agency working on sanitation needs. Even in the camps with decent management, most do not meet international standards for post-disaster cleanliness.

But if the camps are bad, the slums are worse. "People are worried about the camps, but the camps have latrines, water, access to health care. I'm not so worried about the camps. The slums are a breeding ground," said Fisher, the top U.N. humanitarian official.

Without access to running water or latrines, many Haitians rely on "flying toilets," using a plastic bag and then throwing it someplace.

Mark Ward, director of the USAID office of foreign disaster assistance, has seen soap work to combat cholera before - most recently in Pakistan, after the summer floods turned into a humanitarian disaster. "We were buying every bar of soap we could find in Pakistan," he said during a tour of the Haitian capital Friday.

USAID is bringing 2 million doses of oral rehydration solution to Haiti this week. "We are going to see a big jump in cases," Ward said. "The good news is people are coming in for treatment.

You want that. But it's the death rates. That's what we want to keep to a minimum."

At University Hospital in Port au Prince, Ward was shown the cholera treatment center, where suffering, stained patients sat on plastic chairs or sprawled on cholera cots, intravenous fluids going into their arms, as they purged themselves of the bacteria. The clinic smelled of chlorine and sickness. The hospital director, Alix Lassegue, said there were shortages of supplies and they were opening another section to handle the coming wave.

On the floor, at the patients' feet, were two white plastic body bags, each with someone inside.