CHOLERA AND BLAME IN RURAL HAITI
(PJStar) - By John Carroll, MD
(Author’s Note: This article was very hard for me to write. My goal was to describe challenges on the ground “fighting the war on cholera” in rural Haiti. I also wanted to emphasize that to “win this war” we have to identify and try to minimize the political agendas regarding cholera. Cholera is much more than identifying dirty water sources, passing out aquatabs, providing oral rehydration solution, tents, and IV fluids. Only if transparency and honesty at all levels are added to traditional modern cholera care, do the poor Haitians in the mountains have a chance against this disease. It is up to us. jc)
When I studied cholera in medical school I didn’t think I would ever take care of anyone with this disease. The black and white photos in medical books of cholera patients always seemed to show some poor soul from Asia or somewhere faraway with his gaunt cheeks and sunken eyes staring nowhere.
And the medical books back then did not link cholera and the roles of social injustice and structural violence back then. And I doubt they do now.
But during the last 15 months I have seen more cholera than I would ever want to and I know now that my old medical books were not exaggerating what cholera does to a person.
Cholera kills lots of people around the world. The cholera bacteria makes a toxin that produces a secretory diarrhea that causes patients to lose incredible amounts of intestinal fluid and slip into shock. They lie in their vomit and stool and die unless they get intravenous rehydration quickly.
And now cholera is very close to home. It’s not in some far away place any more. Cholera is in Haiti.
Haiti has more cholera per capita than any country in the world. Since October, 2010 cholera has sickened 700,000 people and killed 7,000 of them. And these are only the cases we know about. Many more have died uncounted in the mountains of Haiti where about 60% of Haitians live.
Cholera is much more than just a toxic diarrhea that is killing people in all of Haiti’s 10 departments. There is much more involved.
Haiti’s geography is challenging, communication is poor, superstition is high, and corruption is great. Pledged money from the international community during the last two years is all too often never making it to the communities in Haiti with the greatest risk of cholera. It is stolen or is not being used properly to employ Haitians and help Haitians who need it the most.
To control cholera in Haiti there needs to be a multifaceted approach set up by experts but engaging local citizens to carry out some of the most important life-critical functions. Cholera has to be attacked from all sides. Expert knowledge, organization, money, and transparency are all needed. And from what I have seen here on the ground, there is a long ways to go.
The rainy season is approaching quickly. And that means clean water will mix with dirty water and the incidence of cholera will increase.
Since January 1, 2012 in the Pestel Commune of southern Haiti we have documented 126 people with cholera who we treated in small cholera tents or buildings set up in four mountain villages.
But Pan-American Health Organization (PAHO) health officials who recently came to Pestel, said that there was not a problem with cholera in Pestel.
Denial and bad statistics do not help “put the lid” on this horrible cholera epidemic. You see cholera is a “political disease” here and obfuscation and lack of transparency are all part of the problem.
And can you imagine trying to keep a person alive who is losing almost all his body fluids in a tent that is over 100 degrees F inside? I know we are not offering them good basic clinical care in our make shift cholera tents. But it is all the rural Haitians have and it is the best we can do right now.
And we all like to place the “blame of cholera” on someone else.
The UN soldiers (MINUSTAH) unknowingly brought cholera to Haiti in October, 2010. And with the help of Haitian Sanco Company, the soldiers dumped their human waste into a little river that flowed into the central river in Haiti’s breadbasket, the Artibonite Valley.
Cholera was unleashed and started to kill people quickly as they stumbled or were carried to the hospital. Many patients did not make it to the hospital and died on the road.
Like any big organization, the UN denied that they could have been the culprits. Who would want to admit they were responsible for introducing a disease that would kill thousands of Haitians? The UN was supposed to be protecting Haitians.
Haitians are very afraid of cholera and are very angry that cholera is here to stay.
In December 2010 there were 45 murders here in southern Haiti of natural Haitian healers who the people presumed were practicing cholera-linked witchcraft. They were blamed and summarily stoned and hacked to death before their bodies were burned in the streets.
And poor Haitians are blamed all the time for using bad hygiene and “not washing their hands” or using latrines. But the problem is they often don’t have access to either.
During the last several weeks I have lived with very poor Haitians in the mountains of Pestel and I felt filthy. I didn’t take a real shower in 10 days. But I had fairly clean water to drink…which is a luxury that tens of thousands of Haitians surrounding me in the mountains do not have.
And if all of this doesn’t sound bad enough, some of the Haitian nurses staffing cholera treatment units in Pestel had not received a salary from the Haitian government since September, 2011. I would not think that would encourage their spirits. But these nurses came to work anyway. Taking good care of a sick cholera patient is difficult nursing work.
And these Haitian nurses make a grand total of 300 dollars US per month. Why were they not paid? The Haitian doctor in charge of the whole Pestel Commune was pleading that his nurses get paid.
And so we went to bat for the Haitian nurses at a “high level” and the salaries they were owed for the last three months were paid to them almost immediately. I wonder what the problem was?
And how about the Haitian hospital in the village of Pestel? It is a Haitian government hospital. And it is absolutely horrible. It is an embarrassment. There are five broken down beds serving about 80,000 people in the Pestel area. There are a couple of Haitian doctors and one Cuban doctor that staff the outpatient clinic at the hospital. The head doctor shook his head and showed me the ancient rusty green oxygen tanks that don’t function in the corner of the room where our newly admitted 58-year-old lady in florid heart failure died in front of us.
And the cholera tent is despicable at the Pestel hospital. I don’t have adequate words to describe its filth and the misery inside of it.
And even if I had “adequate words” to describe the misery on the ground in Pestel, I started to have uninvited visitors at night asking me where my documented permission was that stated I could work in Pestel. And I was told my posts on the internet needed to be read by the powers that be BEFORE I posted them. And I was told NOT to take more photographs.
So along with the poor Haitians who don’t wash their hands in clean water, the messenger in the mountains became a problem too.
With cholera in Haiti, someone always needs to be blamed.
John A. Carroll, MD
www.haitianhearts.org
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