ARTICLE - CHOLERA RAGES IN RURAL HAITI

CHOLERA RAGES IN RURAL HAITI, OVERWHELMING CLINICS
(San Francisco Chronicle) - AP - By Ben Fox

LIMBE - A gray-haired woman, her eyes sunken and unfocused from dehydration, stumbles up a dirt path slumped on the shoulder of a young man, heading to a rural clinic so overcrowded that plastic tarps have been strung up outside to shade dozens who can't fit inside.

On the path to the clinic, another cholera victim lies dazed, her head bleeding because she couldn't stay atop the motorcycle taxi that carried her along the twisting country roads to the treatment center on the front line of Haiti's sudden battle with cholera.

Nearby, a 16-month-old girl wails as a nurse prods her with a needle, trying to find a vein for the intravenous fluids she needs to save her life.

Many feared Haiti's growing epidemic would overwhelm a capital teeming with more than 1 million people left homeless by January's earthquake. But, so far, it is the countryside seeing the worst of an epidemic that has killed nearly 1,900 people since erupting less than two months ago.

Rural clinics are overrun by a spectral parade of the sick, straining staff and supplies at medical outposts that could barely handle their needs before the epidemic.

At the three-room clinic near Limbe, in northern Haiti, a handful of doctors and nurses are treating 120 people packed into three rooms.

"It's really attacking us," Guy Valcoure, grandfather of the 16-month-old, says of the cholera. He piled on the back of a motorcycle with the baby and her mother to make a 40-minute ride in pre-dawn gloom to reach the clinic.

Holding a plastic cup in case his granddaughter gains enough strength to drink some water, Valcoure watches anxiously as a nurse tries without success to find a vein to give her intravenous fluids. Eventually, a doctor manages to get an IV into the baby's foot. "She's going to be OK," the nurse tells Valcoure.

Not everyone is so fortunate. It was too late to save an old woman carried to the clinic on a door over the weekend, says Dr. Benson Sergiles, a doctor from Cap-Haitien on loan to the clinic. "It's getting worse by the day," he says, his eyes bleary from being up all night.

And experts say the disease has not yet reached its peak.

The Health Ministry says there have been more than 80,000 cases since cholera was first detected in late October and the Pan-American Health Organization projects it could sicken 650,000 people over the next six months.

U.N. Secretary-General Ban Ki-moon, Reporting to the General Assembly on Friday, said that statistics about the epidemic are rough estimates because the cases are concentrated in slums and rural areas with little access to health care.

"Our teams believe the actual number of deaths and current infections may, in fact, be up to twice as high," he said, adding that Haiti will require hundreds of more doctors, nurses and thousands of community health workers to deal with the outbreak.

A makeshift clinic run by the aid group Doctors Without Borders in Cap-Haitien is seeing 250 patients a day and expects two or three times as many in coming weeks, said Dr. Esther Sterk, a physician from the Netherlands in charge of the treatment center in a crowded gymnasium.

The cases are also rising farther into the countryside, as at the little clinic near Limbe.

"I don't think we're anywhere near the end of this," said Dr. John Jensen, a Canadian doctor volunteering with his wife, a nurse, for nearly a month at the clinic about 12 miles (20 kilometers) west of Cap-Haitien.

Fear over the spread of cholera even triggered a violent witch-hunt in the remote southwestern Grand Anse region, where locals have killed at least 12 neighbors on suspicions they used "black magic" to infect people, national police spokesman Frantz Lerebours said Thursday.

Cholera made its first appearance on record in Haiti near the central town of Mirebalais. From there it spread north through the Artibonite region. It has sickened thousands in the capital, but it is the vast rural population that is most vulnerable because cholera is spread by bacteria in contaminated water, and poor rural people often have no access to clean water and no clinics nearby.

"Most Haitians live in rural areas and most don't have latrines," said Dr. Louise Ivers of the medical aid group Partners in Health. "Most people have to do their business in a hole in the back garden and drink water from an unprotected source."

It is these people who have the fewest options when they get sick. "Why do you die from cholera? Because you don't have access to health care," Ivers said.

A hospital in the central Haitian city of Maissade has just two physicians to care for a population of 60,000. That center alone had treated 350 cholera patients as of last week, said Dr. Tim Rindlisbacher of Toronto, Canada, who recently worked there as a volunteer with the Canadian aid group Humanity First.

He said he believes many more never got treatment.

"It is easy to miss it in the rural areas," Rindlisbacher said. "There's a lot of people who never make it to a hospital, never make it to a doctor and there's no way of tracking those people."

In much of the countryside, public transportation is rare. The nearest doctor or nurse could be a trek of many hours through the mountains. Even in the cities, ambulances don't exist and cholera patients usually travel by taxi or collective transport.

Associated Press journalists this week came upon four men carrying a 14-year-old boy on a stretcher along a dirt road, his mother trudging alongside. They had been walking four hours from their village to the town of Grand Riu Du Nord, in mountains about 16 miles (25 kilometers) south of Cap-Haitien to reach a clinic staffed by Cuban doctors, who treated the boy.

A maddening fact about cholera, which rapidly drains the bodily fluids from its victims, is that it is easy to treat and most people survive if they get medical attention. Doctors Without Borders says the disease has a mortality rate of less than 1.5 percent among people who reach the more than two dozen treatment centers it operates around Haiti.

Yet no one knows how many are dying uncounted and alone out in the countryside.

One small village visited by Guytho Alphonse, a public health promoter for the aid group Oxfam, is a three-hour walk from the nearest medical clinic. He said villagers told him that an entire family of six had died of the disease. His visit was meant to prevent such tragedies: He was distributing oral rehydration mixture and chlorine for treating wells.

Dr. Thony Michlet Voltaire, who runs a hospital in the town of Sante Borgne, about 40 miles (65 kilometers) from Cap-Haitien, said he was getting 40 patients a day. He said seven people had arrived in such bad shape over the past week that they could not be saved.

"A lot of people are dying at home because they can't make it to us," said Voltaire, who said his clinic, the Alliance Sante Borgne, was in dire need of medicine, volunteers and such basic supplies as clean bed sheets.

Aid groups and international organizations such as the United Nations are working on campaigns to confront the outbreak, but Ivers and others said it will take an army of health workers to stop cholera's spread.

"Let me put it this way: We have 3,000 community health workers and we are hiring more ... as many as we can," she said.