Tuesday, March 8, 2011

ARTICLE - HAITI IN THE TIME OF CHOLERA

HAITI IN THE TIME OF CHOLERA
(Pittsburgh Post-Gazette) - By Dennis B. Roddy

As disease spreads, mountain people cope -- without roads, clean water or sewers

BASTIEN, Haiti -- In a place of cholera, laughing children carry creek water past the coffin maker's house.

The water is from a rivulet in the mountains and it pools into a concrete cistern that water-starved people here call simply "The Source." Families send their children down the hillside with buckets, bowls, any container, really. One had an old antifreeze jug. They dip into the pool, then climb a path more like a ditch to a road more like a path and on to homes more like shacks where the parents drop chlorine bleach into the water and hope for the best.

"Work is work," says Marlus Saint Jean. He is 46 and stands in a hammering sunlight on a field a rock-strewn mile from his house. In his side yard is a half-completed casket. He tries to have one in reserve when the need arises. Some people buy in advance and store their caskets against the inevitable day.

"If someone sees it and they need it, they'll buy it," he shrugs.

He has yet to build a coffin for a cholera victim. For now, his clientele is the usual assortment of victims of routine diseases and, for the lucky ones, old age.

In the past three months, dozens of his neighbors have been rushed to the hospital in Deschapelles, where frantic volunteers have poured antidotes into stomachs that can keep them down, or shoved needles into arms when stomachs won't hold. The strange thing is that Mr. Saint Jean seems oblivious to how quickly this will affect his business.

"I don't think the people understand the magnitude of this epidemic," said Eddie Rawson. With his father, Ian, he works at the Hopital Albert Schweitzer. Cholera was reported in Haiti in 1923 among American Marines who occupied the country to keep it safe for commerce. There were no authoritative ways to test, so doctors who declared it cholera were only using an educated guess.

After last year's earthquake, a strain native to Southeast Asia turned up in a branch of the Artibonite River, the main water source for this region. To date, 3,600 people have died as the contagion spread from here to Port-au-Prince, in human waste. In Haiti such a spread is as casual as someone emptying a bedpan or bucket into a ditch.

To reach Bastien, Eddie banged a pickup truck over a road unworthy of the name, all the time beaming with pride. He and others had cut the thing through to Bastien, filling cavernous holes with big rocks. In the rocky Verrettes district of the Artibonite Region, a road is the thing where nothing is growing. A driver points the truck, hits low gear, and lays on the horn to scatter the goats.

When cholera came to the mountains, the locals were mystified. They are accustomed to water-born sickness, but like most recurring horrors in Haiti, it usually passes. Two people died quickly, literally emptied of their body fluids by diarrhea and vomiting. People strapped neighbors onto the doors of their homes, propped the doors on their heads, and walked. In the village of Terre Nette there are no roads. People sick with cholera walked two hours to the nearest road, where a truck could take them if they could find one.

"What we need here is an ambulance service," Eddie Rawson said. "I want to drag people up here and show them how it is."

This is how it is: Thousands of people live on the mountainsides in places with no running water, schools, passable roads or sewers. It is a land of outdoor holes as toilets, a spot where giving a pet a name is odd because the few animals are either eaten or used to carry crops. Childhood is a pants-optional existence and the one way to keep from dying of the water is to calculate how much Clorox to pour in the container before pouring in the water from the rivulets that run off the barren hillsides.

They used to squeeze a citron -- a bitter, green-skinned Haitian orange -- into the water and let the water jug stand in the sun for a day until the citric acid killed any germs. Naftelan Orleus, 9, had an old anti-freeze jug on her head, taking water from The Source. At home, someone would drop bleach or special tablets handed out by the hospital to kill what might or might not be brewing inside.

In this village, a coffin maker is a public servant akin to a philanthropist, except that at the pivotal juncture he receives rather than gives the money. A casket costs about $250 American. Business is slow, if only because of the clinic. The disease will likely climb the mountain with each visitor, Eddie Rawson said. Some people don't even know about it yet.

Now that cholera dwells in the Haitian biological system, it will return again and again and, soon enough, Mr. Saint Jean will find a market for his wares.

When he does, he will put down his hoe and leave the field where he grows tumor-like Haitian potatoes and Congo beans. He will buy lumber, perhaps from Jean Obertin Gusten and Dialus Dorilus, who saw at a chaen tree log nearby. The men are shoeless, shirtless and the only piece of metal in their tool kit is the long, two-handled saw with which they cut their way down the length of the log.

Haiti once had trees, but they were stripped by French colonists who carried slaves to the island and didn't want to send the boats back empty. Now, Mr. Gusten, when the opportunity arises, buys a single tree and cuts it down when someone needs wood.

The caskets in the mountains are plain wood but carefully detailed. Mr. Saint Jean likes to vary designs and decoration just for a change of pace.

The funeral ritual will be as it ever is here. People will come and pay cash for the coffin. "They will take it to their house, put the person inside, and then take it to the cemetery," says Mr. Saint Jean. If the person dies in the hospital, it will be a day or two longer at the morgue.

"People will stand around the grave and pray for the spirit," he says. "Then they will go to their house, cook food and eat, sometimes drink, and they'll talk about the dead person."

Mr. Saint Jean, like his neighbors, is a follower of voodoo. So there will be a few other rituals. The most notable is pouring a bottle of Barbancourt rum over the grave to send a drink into the afterlife to the soul just departed. Barbancourt is the national rum and, in the mountains of Haiti, if you drank it in life you drink it in death.

If Mr. Saint Jean has few worries about being made busy, the alarm is sounding nearby. In the market town of Verrette, the restaurants have laminated signs advising people about to sit down to dinner on ways to avoid cholera.

If it comes -- when it comes, in Eddie Rawson's view -- Mr. Saint Jean, like everyone else here, will rely on the help of people willing to strap him on a door and trot him to the nearest car to the hospital.

He motions to a friend hoeing the field alongside him.

"If I get sick, he will take me," he says. "If he gets sick, I will take him."

He does not say what he'll do if they both get sick.

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