ELK GROVE MOM'S 'LITTLE PROJECT' SAVES THOUSANDS IN HAITI
(Daily Herald) - By Jamie Sotonoff
Lisa Ballantine repeatedly describes herself as “just a mom,” but she also provides clean drinking water to hundreds of thousands of people in Third World countries and helps prevent the spread of cholera in Haiti.
Using what she learned from Northern Illinois University ceramics arts teacher Manny Hernandez, Ballantine invented a clay water filter that can be made by local people in developing countries using readily available materials.
There's a patent pending on her FilterPure water filtration system, and it's become a nonprofit business with factories in the Dominican Republic, Haiti and Tanzania. Ballantine's long list of customers includes Addison-based Lutheran Church Charities, Oxfam, Save the Children and the World Health Organization.
“We're growing so fast right now, our biggest challenge is meeting demand,” said Ballantine, 43, a former Wayne resident who now lives in Elk Grove Village. “We hope to build another three factories in Haiti next year.”
In a few weeks, Ballantine will break ground on FilterPure's International Training Center in the Dominican Republic, where she spends half the year with her husband, Michael, who is a developer there.
With encouragement from public health experts at major American universities, Ballantine will train people from all over the world how to make FilterPure filters so they can take that knowledge to all corners of the globe.
“I'm just a mom who started a little project, and now it's taking off,” she said.
An idea is born
Fifteen years ago, Ballantine was a stay-at-home mom who home-schooled her four children and never traveled outside the U.S. In 2000, the entire family spent a life-changing year as missionaries in the Dominican Republic.
“I'm a Christian, and I believe my life is to serve other people,” she said. “But I remember going into these homes and thinking, ‘I'm not leaving them with anything practical they can use.'”
The family returned home in 2001 so the children could finish their educations at Streamwood High School and Wheaton Academy. That's when Ballantine, a college dropout, went through a “What do I do with my life?” quandary. She decided to enroll at NIU and study ceramic arts.
While in a jewelry class taught by Hernandez, she discovered he knew a lot about water filters.
Immediately, she connected that to the lack of potable water in the Dominican Republic and realized she could help people there.
“I told (Hernandez), ‘Teach me everything you know,'” she said.
Ballantine designed an 8-pound ceramic filter made of clay, silver and sawdust. It fits inside a plastic bucket with a tap at the bottom. Dirty water seeps through the filter at a rate of 2 liters per hour, and 99.99 percent of the dangerous bacteria is removed so the water comes out clear and safe to drink.
“It's sustainable in a Third World environment, and that's important,” Ballantine said.
She started manufacturing the filters in the Dominican Republic. Business hummed along, and the factory churned out about 1,000 filters a month, which NGOs (nongovernmental charity organizations) distributed.
Then the devastating earthquake hit Haiti, the country that shares an island with the Dominican Republic, and Ballantine ramped up production. After repeatedly driving her water filters into Haiti, she eventually opened a FilterPure factory there in an old floor and ceiling tile factory and employed locals to run it. Now that factory churns out 1,500 water filters a month the maximum capacity and she is booked with orders for the next six months.
The FilterPure filters, which cost $30 each to produce, are sold for $1 or $2 and can provide a family with clean water for five years. She said it's important to charge people for the filters, or else they place no value on them.
“There are a lot of Americans who want to help, and that's great. But they need to use local people and teach them how to sustain it,” she said. “After the earthquake (in Haiti), what did everyone do? They sent plastic bottles of water. Why did we think that was the solution? ... I saw a pile of empty plastic bottles three stories high.”
Charities often try to help by bringing in unsustainable products like foreign-made filters with short life spans but Ballantine says that provides only temporary help. The FilterPure filters can be made in developing countries by locals, using local materials.
Begging for water
The Ballantines find the situation in Haiti particularly heartbreaking. They don't see any quick fixes to the problems there but say providing people with clean drinking water is a major step forward and will help control the recent cholera outbreak that's killed thousands of people.
“We've seen kids begging for water. Begging. For water. People drinking out of dirty puddles,” said Michael Ballantine, a Palatine native. “It's really bad.”
Michael is proud of his wife and recalled a story of a woman who wanted to help Mother Teresa feed the poor in India and was told to “find your own Calcutta.” He said his wife, perhaps unintentionally, did just that.
“This is her Calcutta,” Michael said.
“My life is a little different than I thought it was going to be,” Lisa adds, laughing. “But I now know that average people can make a difference. I'm just a regular old mom. Anyone can do it. Just go out there and involve yourself.”
To sponsor a filter for a family, or more information on FilterPure, visit filterpurefilters.org.
Monday, December 20, 2010
ARTICLE - WASTE COLLECTION HOTLINE
AMERICAN RED CROSS FUNDING WASTE-COLLECTION HOTLINE IN HAITI
(PR Newswire) - Source - American Red Cross - www.redcross.org
WASHINGTON (Dec.2) -- The American Red Cross today announced $1.8 million in funding for a waste-collection hotline and removal network in Port-au-Prince to address a major sanitation problem in the Haitian capital.
The goal of the project is to improve solid-waste disposal, particularly in and around the many spontaneous settlements where people displaced by the January 12th earthquake are still living.
The program will be implemented in partnership with Catholic Relief Services and Disaster Waste Recovery.
"This hotline and removal service will improve sanitation for many vulnerable people living in camps around Port-au-Prince," said Ricardo Caivano, Country Representative for the American Red Cross in Haiti. "As the current cholera outbreak makes clear, it is vital to tackle health and sanitation issues in tandem."
Haiti's capital had a major problem with solid waste before the earthquake and that has been exacerbated since then. Trash and other waste is piled up in market areas, along main thoroughfares, and more recently within camps. This, in turn, creates breeding grounds for rodents, flies and mosquitoes and increases the risk of communicable and water-borne diseases.
This project will establish a solid-waste collection network in certain underserved areas where private contractors and the government agency responsible for solid-waste collection will gather waste at designated areas and dispose of it in authorized governmental dumpsites.
A central clearing house (telephone and website access) for waste collection from camps will be created so registered community members, nonprofit organizations, and private contractors may request or provide services. Through this hotline, underserved communities will be linked with identified contractors within their commune to collect and haul waste to government approved dumpsites. The program will involve SMCRS -- the government agency responsible for waste collection – and recognizes that it will remain the principal waste-collection provider. It will also identify and coordinate with a cluster of other waste-collection contractors to serve areas where the government does not operate or has limited capacity.
(PR Newswire) - Source - American Red Cross - www.redcross.org
WASHINGTON (Dec.2) -- The American Red Cross today announced $1.8 million in funding for a waste-collection hotline and removal network in Port-au-Prince to address a major sanitation problem in the Haitian capital.
The goal of the project is to improve solid-waste disposal, particularly in and around the many spontaneous settlements where people displaced by the January 12th earthquake are still living.
The program will be implemented in partnership with Catholic Relief Services and Disaster Waste Recovery.
"This hotline and removal service will improve sanitation for many vulnerable people living in camps around Port-au-Prince," said Ricardo Caivano, Country Representative for the American Red Cross in Haiti. "As the current cholera outbreak makes clear, it is vital to tackle health and sanitation issues in tandem."
Haiti's capital had a major problem with solid waste before the earthquake and that has been exacerbated since then. Trash and other waste is piled up in market areas, along main thoroughfares, and more recently within camps. This, in turn, creates breeding grounds for rodents, flies and mosquitoes and increases the risk of communicable and water-borne diseases.
This project will establish a solid-waste collection network in certain underserved areas where private contractors and the government agency responsible for solid-waste collection will gather waste at designated areas and dispose of it in authorized governmental dumpsites.
A central clearing house (telephone and website access) for waste collection from camps will be created so registered community members, nonprofit organizations, and private contractors may request or provide services. Through this hotline, underserved communities will be linked with identified contractors within their commune to collect and haul waste to government approved dumpsites. The program will involve SMCRS -- the government agency responsible for waste collection – and recognizes that it will remain the principal waste-collection provider. It will also identify and coordinate with a cluster of other waste-collection contractors to serve areas where the government does not operate or has limited capacity.
ARTICLE - VOLUNTEERS CLEAR CANALS
HAITI: VOLUNTEERS CLEAR CANALS AND FIGHT CHOLERA
(ReliefWeb) - Source: British Red Cross
As cholera continues to spread across Haiti, a community canal-clearing project is underway in the capital, as part of a sanitation, shelter and livelihoods programme helping people get back on their feet.
The British Red Cross project in Delmas 19, Port-au-Prince, is helping a community where the earthquake destroyed houses and drainage canals, rubble still blocks roads and alleyways and broken pipes spout water across the area.
The sanitation facilities there were almost non-existent before the quake, and the destruction of what little there was has meant residents have turned to using broken pipes for washing and for their water supply, using open canals as toilets and rubbish dumps.
Community involvement
Chris Brewer, British Red Cross sanitation manager, explained: "All these elements are linked together and helping people recover is not only about building houses or toilets. It also requires community involvement to identify problems and solutions to reduce future risks, such as implementing a communal public health plan, clearing rubble and drainage canals, and identifying possible shelter solutions for both owners and renters."
Around 100 community volunteers came forward immediately to get involved with the project, beginning with clearing the drainage canals that are blocked with waste and cause regular flooding of the neighbourhood, particularly during the rainy season.
Community volunteers
Vanette Janvier, 23, one of the community team leaders, works under the hot Haitian sun filling sacks of rubbish with seemingly endless quantities of foul smelling refuse. She said: "When it rains in our neighbourhood, the canals overflow because of all the rubbish. People's homes get flooded, and they can't sleep at night. Many have to evacuate to higher ground until the water level recedes.
"I've been living here for most of my life. I'm happy to be doing something for the community and I take pride in my work. This job that we are doing is going to really help people in the neighbourhood and improve their quality of life."
Chris said: "As well as the obvious benefits clearing the canal will bring, this project is also an opportunity for us to get to know the community. We want to encourage them to take things into their own hands and make them realise that they can work as a team and get tangible results."
Sustainable solutions
"Clearing the canal is also a prequel to getting a long-term sustainable solid waste management system in place," Chris explained. "We are installing bins in the community and replacing the one toilet in the neighbourhood – an open hole over the canal – with proper latrines that will be maintained by the community. Our support will also expand into supporting small business development and helping find shelter solutions for people who lost their homes."
It is not only about providing alternative solutions to rubbish dumping, but also about changing mindsets. This is particularly important at a time when cholera is spreading across the city, and areas with little sanitation infrastructure are likely to be badly affected. Red Cross hygiene promotion volunteers are touring Delmas 19 spreading messages both about cholera prevention and safe and healthy waste disposal.
Chris said: "No one wants their homes flooded with rubbish, or to defecate above an open canal. This is the just the first step in a two-year plan to help regenerate the neighbourhood and we are already seeing improvements for the lives of residents in Delmas 19."
(ReliefWeb) - Source: British Red Cross
As cholera continues to spread across Haiti, a community canal-clearing project is underway in the capital, as part of a sanitation, shelter and livelihoods programme helping people get back on their feet.
The British Red Cross project in Delmas 19, Port-au-Prince, is helping a community where the earthquake destroyed houses and drainage canals, rubble still blocks roads and alleyways and broken pipes spout water across the area.
The sanitation facilities there were almost non-existent before the quake, and the destruction of what little there was has meant residents have turned to using broken pipes for washing and for their water supply, using open canals as toilets and rubbish dumps.
Community involvement
Chris Brewer, British Red Cross sanitation manager, explained: "All these elements are linked together and helping people recover is not only about building houses or toilets. It also requires community involvement to identify problems and solutions to reduce future risks, such as implementing a communal public health plan, clearing rubble and drainage canals, and identifying possible shelter solutions for both owners and renters."
Around 100 community volunteers came forward immediately to get involved with the project, beginning with clearing the drainage canals that are blocked with waste and cause regular flooding of the neighbourhood, particularly during the rainy season.
Community volunteers
Vanette Janvier, 23, one of the community team leaders, works under the hot Haitian sun filling sacks of rubbish with seemingly endless quantities of foul smelling refuse. She said: "When it rains in our neighbourhood, the canals overflow because of all the rubbish. People's homes get flooded, and they can't sleep at night. Many have to evacuate to higher ground until the water level recedes.
"I've been living here for most of my life. I'm happy to be doing something for the community and I take pride in my work. This job that we are doing is going to really help people in the neighbourhood and improve their quality of life."
Chris said: "As well as the obvious benefits clearing the canal will bring, this project is also an opportunity for us to get to know the community. We want to encourage them to take things into their own hands and make them realise that they can work as a team and get tangible results."
Sustainable solutions
"Clearing the canal is also a prequel to getting a long-term sustainable solid waste management system in place," Chris explained. "We are installing bins in the community and replacing the one toilet in the neighbourhood – an open hole over the canal – with proper latrines that will be maintained by the community. Our support will also expand into supporting small business development and helping find shelter solutions for people who lost their homes."
It is not only about providing alternative solutions to rubbish dumping, but also about changing mindsets. This is particularly important at a time when cholera is spreading across the city, and areas with little sanitation infrastructure are likely to be badly affected. Red Cross hygiene promotion volunteers are touring Delmas 19 spreading messages both about cholera prevention and safe and healthy waste disposal.
Chris said: "No one wants their homes flooded with rubbish, or to defecate above an open canal. This is the just the first step in a two-year plan to help regenerate the neighbourhood and we are already seeing improvements for the lives of residents in Delmas 19."
ARTICLE - NUTRITION IN A TIME OF CHOLERA
NUTRITION IN A TIME OF CHOLERA: A CHALLENGE FOR HAITIAN MOTHERS AND BABIES
(ReliefWeb) - Source: United Nations Children's Fund (UNICEF)
By Tania McBride
PORT-AU-PRINCE – In the cramped and squalid conditions of the tented city in Mais Gate, a camp for Haitians displaced by the January earthquake, baby Sebastian brings a sparkle to his mother Lucienne's eyes.
At eight months, dribbling from cutting teeth and tipping the scales at a whopping 11 kg, Sebastian is alert, sitting up, clambering over his mother and almost standing on his own. He is the Brutus in the baby tent, an example to the young mothers of a well-nourished, breastfed baby.
Lucienne gives credit for Sebastian's good health and growth to the nurses at the tent – which is run by the non-governmental organization Concern and supported by UNICEF.
"Before the earthquake, I had no idea about how to handle a baby, how to even hold a baby, and certainly I knew nothing about breastfeeding," she recalls. "In some ways, it was due to the tremblement that I have this healthy boy."
Breastfed children thrive
On the day of the quake, Lucienne was in her house with three other family members. Spared injury but unable to live in the damaged house afterwards, she has been camped in Mais Gate, surviving as best she can and going to the baby tent every day with Sebastian.
"I came to the tents when I was heavily pregnant with Sebastian," she says. "With the information I received from Mauvette, I was able to prepare ahead of time what I would need to ensure Sebastian's survival."
Head nurse Mauvette, who lectured at a Port-au-Prince nursing school prior to the earthquake, has seen over 450 women through the baby-tent programme in Mais Gate since it was established in early February. She says education about the importance of exclusive breastfeeding and infant care in these difficult conditions is critical – not only for mothers but for fathers and other caregivers.
"Many of the mothers who came to the tent had fed their babies some form of liquids after they were born and solid foods before they reached six months," notes Mauvette. "With a lot of education, we were able to convert them exclusively to breastfeeding, and their children are thriving."
Education dispels myths
The baby tent staff also has worked to dispel myths associated with the earthquake. Many women feared that their breast milk had been affected by the quake and would harm their babies, for example. Mauvette and her team, including two nurses and a psychologist, reassured the mothers through education sessions. Now they report that approximately 80 per cent of the mothers in their caseload practice exclusive breastfeeding.
"This is extremely encouraging in a country like Haiti, as there is conclusive global evidence that exclusive breastfeeding is one the most effective child-survival interventions," says UNICEF Haiti Chief of Nutrition Dr. Mohamed A. Ayoya. "What we are seeing being practiced in this baby tent is being replicated in other UNICEF-supported baby tents, in community-based therapeutic programmes and also in stabilization centres for children with severe acute malnutrition."
Beyond the current emergency, adds Dr. Ayoya, a long-term, sustainable strategy will be needed to promote proper feeding for infants and young children throughout Haiti. "It's essential that a range of people are involved – women, men health professionals and traditional leaders," he says.
Preventing cholera
Meanwhile, at Mais Gate camp, stagnant pools of water line the makeshift roads and people live on top of each other, with little or no privacy, in makeshift tarpaulins or tents supplied by aid agencies. Men, women and children constantly traipse to the camp's water points to fill containers of water for drinking, washing and cooking.
The Concern baby tent is an oasis in a time of cholera, which broke out in Haiti in October.
Anyone who enters the tent has to wash his or her hands thoroughly with chlorine-treated water and soap. Mauvette vigilantly polices the visitors; those who don't wash thoroughly enough are given a demonstration of how to do so and a lecture on the importance of preventing cholera.
"Each of these mothers is receiving soap, oral rehydration salts and Aquatabs to help them through this time when cholera is rife in Haiti," the head nurse explains, referring to supplies intended to prevent and treat the diarrhoeal dehydration associated with the waterborne disease. "The baby tents are not just a place to learn about how to exclusively breastfeed," she says. "In many ways they are a vital lifeline to information that mothers and fathers need in order to keep their families healthy and safe from the spread of disease."
Lucienne agrees. She is thankful for the camaraderie and support of the doctor, nurses and other mothers in the baby tents. However, she shakes her head when she is asked if she would like to have more children. "These are the worst conditions to bring up a child," she says. "Until my family's situation changes, I am not going to subject another child to this sort of life."
(ReliefWeb) - Source: United Nations Children's Fund (UNICEF)
By Tania McBride
PORT-AU-PRINCE – In the cramped and squalid conditions of the tented city in Mais Gate, a camp for Haitians displaced by the January earthquake, baby Sebastian brings a sparkle to his mother Lucienne's eyes.
At eight months, dribbling from cutting teeth and tipping the scales at a whopping 11 kg, Sebastian is alert, sitting up, clambering over his mother and almost standing on his own. He is the Brutus in the baby tent, an example to the young mothers of a well-nourished, breastfed baby.
Lucienne gives credit for Sebastian's good health and growth to the nurses at the tent – which is run by the non-governmental organization Concern and supported by UNICEF.
"Before the earthquake, I had no idea about how to handle a baby, how to even hold a baby, and certainly I knew nothing about breastfeeding," she recalls. "In some ways, it was due to the tremblement that I have this healthy boy."
Breastfed children thrive
On the day of the quake, Lucienne was in her house with three other family members. Spared injury but unable to live in the damaged house afterwards, she has been camped in Mais Gate, surviving as best she can and going to the baby tent every day with Sebastian.
"I came to the tents when I was heavily pregnant with Sebastian," she says. "With the information I received from Mauvette, I was able to prepare ahead of time what I would need to ensure Sebastian's survival."
Head nurse Mauvette, who lectured at a Port-au-Prince nursing school prior to the earthquake, has seen over 450 women through the baby-tent programme in Mais Gate since it was established in early February. She says education about the importance of exclusive breastfeeding and infant care in these difficult conditions is critical – not only for mothers but for fathers and other caregivers.
"Many of the mothers who came to the tent had fed their babies some form of liquids after they were born and solid foods before they reached six months," notes Mauvette. "With a lot of education, we were able to convert them exclusively to breastfeeding, and their children are thriving."
Education dispels myths
The baby tent staff also has worked to dispel myths associated with the earthquake. Many women feared that their breast milk had been affected by the quake and would harm their babies, for example. Mauvette and her team, including two nurses and a psychologist, reassured the mothers through education sessions. Now they report that approximately 80 per cent of the mothers in their caseload practice exclusive breastfeeding.
"This is extremely encouraging in a country like Haiti, as there is conclusive global evidence that exclusive breastfeeding is one the most effective child-survival interventions," says UNICEF Haiti Chief of Nutrition Dr. Mohamed A. Ayoya. "What we are seeing being practiced in this baby tent is being replicated in other UNICEF-supported baby tents, in community-based therapeutic programmes and also in stabilization centres for children with severe acute malnutrition."
Beyond the current emergency, adds Dr. Ayoya, a long-term, sustainable strategy will be needed to promote proper feeding for infants and young children throughout Haiti. "It's essential that a range of people are involved – women, men health professionals and traditional leaders," he says.
Preventing cholera
Meanwhile, at Mais Gate camp, stagnant pools of water line the makeshift roads and people live on top of each other, with little or no privacy, in makeshift tarpaulins or tents supplied by aid agencies. Men, women and children constantly traipse to the camp's water points to fill containers of water for drinking, washing and cooking.
The Concern baby tent is an oasis in a time of cholera, which broke out in Haiti in October.
Anyone who enters the tent has to wash his or her hands thoroughly with chlorine-treated water and soap. Mauvette vigilantly polices the visitors; those who don't wash thoroughly enough are given a demonstration of how to do so and a lecture on the importance of preventing cholera.
"Each of these mothers is receiving soap, oral rehydration salts and Aquatabs to help them through this time when cholera is rife in Haiti," the head nurse explains, referring to supplies intended to prevent and treat the diarrhoeal dehydration associated with the waterborne disease. "The baby tents are not just a place to learn about how to exclusively breastfeed," she says. "In many ways they are a vital lifeline to information that mothers and fathers need in order to keep their families healthy and safe from the spread of disease."
Lucienne agrees. She is thankful for the camaraderie and support of the doctor, nurses and other mothers in the baby tents. However, she shakes her head when she is asked if she would like to have more children. "These are the worst conditions to bring up a child," she says. "Until my family's situation changes, I am not going to subject another child to this sort of life."
ARTICLE - A DOCTOR'S WORD: CHOLERA
A DOCTOR'S WORD: CHOLERA AND HAITI'S CONTINUING HEALTH NIGHTMARE
(New America Media)
New America Media, Question & Answer, Erin Marcus, M.D.
EDITOR”S NOTE: The Obama administration announced earlier this week that it is lifting its ban on deportations to Haiti. Immigration and Customs Enforcement says it expects to resume deporting Haitian immigrants next month—the one-year anniversary of the earthquake that killed more than 300,000 people. Human rights groups have criticized the move amidst a cholera outbreak, election-related violence and the ongoing devastation from the earthquake.
To hear more about the situation on the ground, NAM contributor Dr. Erin Marcus spoke with Dr. Andre Vulcain, co-director of the Justinien Hospital family medicine residency training program in Cap Haitien, a collaborative program between the University of Miami Haiti project and the Haitian Ministry of Health. He divides his time between Haiti and Miami and has advised the Haitian Ministry of Health’s HIV care program.
NAM: You recently returned from a three-week trip to Haiti, where you were treating cholera patients. What was the situation you faced during this most recent trip?
Vulcain: When they announced there was a formal epidemic, we started putting together an embryonic cholera treatment center in Cap Haitien even before [the epidemic] got there. We expected 25 to 50 patients a day, but there was a quick escalation of the epidemic. It was a very difficult situation. The center was designed for 200 to 250 patients and they were taking care of 600 patients.
The big problem was there were not enough trained human resources and not enough beds. I was in charge of a room with 80 patients with three to four nurses. Most of the patients we had were severely dehydrated, and 100 percent needed IV hydration. One week earlier, there was political agitation in the city, and for five or six days, people were staying home or people died in the streets. It was a very difficult situation, but I think our results were good because the mortality rate was maintained below 1 percent.
You were in Haiti during the earthquake, and treated thousands of patients in the immediate aftermath of the disaster. Do you see things worsening from a public health perspective?
Before the earthquake, the public health system was falling apart. Since the earthquake, things are more challenging. We had to divert energy to the earthquake effort itself. The fact that we have to concentrate on the cholera epidemic displaces attention from other healthcare programs, which are already weak. Now, on top of that, you have this election that went bad.
During the past 25 years, Haiti has made progress only in one major indicator of health care status—the infant mortality rate, which has been reduced by 50 percent for the past 20 to 25 years. All the other indicators, [such as] maternal mortality, malnutrition of children, are steadily going up. The maternal mortality now has reached an astronomical level. It’s over 600 maternal deaths for 100,000 live births—[and this was] prior to the earthquake.
What were some of the barriers you faced in caring for cholera patients?
The sheer number of patients was difficult to manage, even though the basic logistics were there. We definitely needed more human resources. But everybody was doing his best.
[More generally[, there is a lack of knowledge about cholera and skills among the health care workforce. This is the first time that we have had cholera in Haiti. We have started a medical education program that will train most of the providers. We think that cholera is here to stay in Haiti for a long time, given the conditions, so it’s important for the whole workforce to be familiar with the cholera epidemic.
What are some of the misconceptions people in Haiti have about cholera?
Some people thought you could contract cholera through the air, and on the street some people were wearing medical masks. But I think the education that’s being done has minimized that.
Some people thought that it could have been something intentional related to some political situation, or something else. The communities that are affected don’t spend a lot of time speculating about those things —they are more interested in how to protect themselves.
Cholera is, in large part, caused by inadequate infrastructure and unclean water. Do you see the epidemic abating anytime soon? Will it be possible for the government to end this epidemic soon, given the need for significant improvements in infrastructure?
Political instability has always had a negative effect on public health programs in Haiti. The ability of the state to provide for the needs of the people has been weakened. You need time to build a sanitation infrastructure. It’s not going to happen tomorrow, it’s more a long-term thing.
What changes have you seen in Haitian society since the disaster?
I think people’s fatalistic attitude has increased. The other thing that is worrisome is that you have so many people living in a tent-city culture. Even in the slums, there was some organization, there was some sense of community, you knew the people close to you. Under a tent, it’s a new environment, new people, way less privacy, you are constantly exposed.
It’s very concerning in terms of how it’s going to affect the values of this society, how people relate with other people, how people express their solidarity, how people are going to value self-reliance, because in those tents, people are totally assisted with food, water, medical care. A child who spends five years under the tent— what kind of mentality does he have, what does he think of life, what is his vision of normalcy when he grows up, what kind of contribution will he be able to make when his reference frame has been to live under a tent for so many years? It’s a big human issue.
Dr. Erin Marcus is associate professor of clinical medicine at the University of Miami Miller School of Medicine.
(New America Media)
New America Media, Question & Answer, Erin Marcus, M.D.
EDITOR”S NOTE: The Obama administration announced earlier this week that it is lifting its ban on deportations to Haiti. Immigration and Customs Enforcement says it expects to resume deporting Haitian immigrants next month—the one-year anniversary of the earthquake that killed more than 300,000 people. Human rights groups have criticized the move amidst a cholera outbreak, election-related violence and the ongoing devastation from the earthquake.
To hear more about the situation on the ground, NAM contributor Dr. Erin Marcus spoke with Dr. Andre Vulcain, co-director of the Justinien Hospital family medicine residency training program in Cap Haitien, a collaborative program between the University of Miami Haiti project and the Haitian Ministry of Health. He divides his time between Haiti and Miami and has advised the Haitian Ministry of Health’s HIV care program.
NAM: You recently returned from a three-week trip to Haiti, where you were treating cholera patients. What was the situation you faced during this most recent trip?
Vulcain: When they announced there was a formal epidemic, we started putting together an embryonic cholera treatment center in Cap Haitien even before [the epidemic] got there. We expected 25 to 50 patients a day, but there was a quick escalation of the epidemic. It was a very difficult situation. The center was designed for 200 to 250 patients and they were taking care of 600 patients.
The big problem was there were not enough trained human resources and not enough beds. I was in charge of a room with 80 patients with three to four nurses. Most of the patients we had were severely dehydrated, and 100 percent needed IV hydration. One week earlier, there was political agitation in the city, and for five or six days, people were staying home or people died in the streets. It was a very difficult situation, but I think our results were good because the mortality rate was maintained below 1 percent.
You were in Haiti during the earthquake, and treated thousands of patients in the immediate aftermath of the disaster. Do you see things worsening from a public health perspective?
Before the earthquake, the public health system was falling apart. Since the earthquake, things are more challenging. We had to divert energy to the earthquake effort itself. The fact that we have to concentrate on the cholera epidemic displaces attention from other healthcare programs, which are already weak. Now, on top of that, you have this election that went bad.
During the past 25 years, Haiti has made progress only in one major indicator of health care status—the infant mortality rate, which has been reduced by 50 percent for the past 20 to 25 years. All the other indicators, [such as] maternal mortality, malnutrition of children, are steadily going up. The maternal mortality now has reached an astronomical level. It’s over 600 maternal deaths for 100,000 live births—[and this was] prior to the earthquake.
What were some of the barriers you faced in caring for cholera patients?
The sheer number of patients was difficult to manage, even though the basic logistics were there. We definitely needed more human resources. But everybody was doing his best.
[More generally[, there is a lack of knowledge about cholera and skills among the health care workforce. This is the first time that we have had cholera in Haiti. We have started a medical education program that will train most of the providers. We think that cholera is here to stay in Haiti for a long time, given the conditions, so it’s important for the whole workforce to be familiar with the cholera epidemic.
What are some of the misconceptions people in Haiti have about cholera?
Some people thought you could contract cholera through the air, and on the street some people were wearing medical masks. But I think the education that’s being done has minimized that.
Some people thought that it could have been something intentional related to some political situation, or something else. The communities that are affected don’t spend a lot of time speculating about those things —they are more interested in how to protect themselves.
Cholera is, in large part, caused by inadequate infrastructure and unclean water. Do you see the epidemic abating anytime soon? Will it be possible for the government to end this epidemic soon, given the need for significant improvements in infrastructure?
Political instability has always had a negative effect on public health programs in Haiti. The ability of the state to provide for the needs of the people has been weakened. You need time to build a sanitation infrastructure. It’s not going to happen tomorrow, it’s more a long-term thing.
What changes have you seen in Haitian society since the disaster?
I think people’s fatalistic attitude has increased. The other thing that is worrisome is that you have so many people living in a tent-city culture. Even in the slums, there was some organization, there was some sense of community, you knew the people close to you. Under a tent, it’s a new environment, new people, way less privacy, you are constantly exposed.
It’s very concerning in terms of how it’s going to affect the values of this society, how people relate with other people, how people express their solidarity, how people are going to value self-reliance, because in those tents, people are totally assisted with food, water, medical care. A child who spends five years under the tent— what kind of mentality does he have, what does he think of life, what is his vision of normalcy when he grows up, what kind of contribution will he be able to make when his reference frame has been to live under a tent for so many years? It’s a big human issue.
Dr. Erin Marcus is associate professor of clinical medicine at the University of Miami Miller School of Medicine.
ARTICLE - PAHO TO PURSUE CHOLERA VACCINATION
HEALTH ORGANIZATION TO PURSUE CHOLERA VACCINATION IN HAITI
(Reuters) - By Jane Sutton
MIAMI - The Pan American Health Organization hopes to start a cholera vaccination program in Haiti by April but must first boost and fund production of the vaccine that is in short supply, the group said on Friday.
The diarrheal disease appeared in the poor Caribbean nation in October for the first time in decades and has sickened 105,000 people and killed more than 2,000, Haitian health officials have said.
PAHO, the American division of the World Health Organization, had previously opposed vaccination in Haiti on grounds that it would be too difficult and expensive.
It changed course on Friday and recommended using the vaccine in Haiti, partly because it has discovered a stockpile of additional vaccine and partly out of recognition that the outbreak would not be halted any time soon.
"This is a disease caused by a bacterium that has a foothold in Haiti and will be in Haiti causing endemic cholera for many years to come," Dr. Jon Andrus, deputy director of PAHO, said in a webcast from Washington. "So if we have options to better our response we really, really need to study those carefully."
Cholera is caused by a water-borne bacteria called Vibrio cholera and is transmitted when contaminated human fecal matter gets into water, food or onto someone's hands. Many people show no symptoms but can pass it along and cholera can cause extremely severe diarrhea and vomiting that will kill within hours by dehydrating victims.
There are only about 200,000 to 300,000 doses of cholera vaccine available in the world at present, and only two companies produce it, said Dr. Ciro de Quadros, executive vice president of the Sabin Vaccine Institute.
Sanofi Aventis' India-based division Shantha makes a vaccine called Shanchol for about $1 a dose, with up to three doses needed for protection, while Netherlands-based Crucell makes another called Dukoral.
PAHO recently discovered a stockpile of more than 1 million doses of Shanchol that would take several months to pack and label, de Quadros said. It has not been prequalified for purchase by the WHO, but that prequalification is expected in the first or second quarter of 2011, he said.
Doctors meeting on Friday under the auspices of PAHO recommended that it meet with the manufacturers to see if they could ramp up production and work with organizations that could help finance the purchase of the vaccines.
"If there would be a (financial) guarantee, both suppliers could produce 2 to 3 million doses a year," de Quadros said.
With that in place, PAHO could start a vaccine-demonstration project in Haiti in March or April, he said.
The doctors said they do not know how many doses would be needed in Haiti and that there were many logistical challenges to work out. Haiti is deeply impoverished and struggling to rebuild from a catastrophic January earthquake that killed more than 250,000 people.
Andrus said the vaccine must be considered "an extra tool in the toolkit" to fight cholera.
Health organizations have so far focused on treating cholera patients with a rehydration fluid containing special sugars and salts, and on educating people about how to halt its spread through hand-washing and sanitation measures.
(Reuters) - By Jane Sutton
MIAMI - The Pan American Health Organization hopes to start a cholera vaccination program in Haiti by April but must first boost and fund production of the vaccine that is in short supply, the group said on Friday.
The diarrheal disease appeared in the poor Caribbean nation in October for the first time in decades and has sickened 105,000 people and killed more than 2,000, Haitian health officials have said.
PAHO, the American division of the World Health Organization, had previously opposed vaccination in Haiti on grounds that it would be too difficult and expensive.
It changed course on Friday and recommended using the vaccine in Haiti, partly because it has discovered a stockpile of additional vaccine and partly out of recognition that the outbreak would not be halted any time soon.
"This is a disease caused by a bacterium that has a foothold in Haiti and will be in Haiti causing endemic cholera for many years to come," Dr. Jon Andrus, deputy director of PAHO, said in a webcast from Washington. "So if we have options to better our response we really, really need to study those carefully."
Cholera is caused by a water-borne bacteria called Vibrio cholera and is transmitted when contaminated human fecal matter gets into water, food or onto someone's hands. Many people show no symptoms but can pass it along and cholera can cause extremely severe diarrhea and vomiting that will kill within hours by dehydrating victims.
There are only about 200,000 to 300,000 doses of cholera vaccine available in the world at present, and only two companies produce it, said Dr. Ciro de Quadros, executive vice president of the Sabin Vaccine Institute.
Sanofi Aventis' India-based division Shantha makes a vaccine called Shanchol for about $1 a dose, with up to three doses needed for protection, while Netherlands-based Crucell makes another called Dukoral.
PAHO recently discovered a stockpile of more than 1 million doses of Shanchol that would take several months to pack and label, de Quadros said. It has not been prequalified for purchase by the WHO, but that prequalification is expected in the first or second quarter of 2011, he said.
Doctors meeting on Friday under the auspices of PAHO recommended that it meet with the manufacturers to see if they could ramp up production and work with organizations that could help finance the purchase of the vaccines.
"If there would be a (financial) guarantee, both suppliers could produce 2 to 3 million doses a year," de Quadros said.
With that in place, PAHO could start a vaccine-demonstration project in Haiti in March or April, he said.
The doctors said they do not know how many doses would be needed in Haiti and that there were many logistical challenges to work out. Haiti is deeply impoverished and struggling to rebuild from a catastrophic January earthquake that killed more than 250,000 people.
Andrus said the vaccine must be considered "an extra tool in the toolkit" to fight cholera.
Health organizations have so far focused on treating cholera patients with a rehydration fluid containing special sugars and salts, and on educating people about how to halt its spread through hand-washing and sanitation measures.
Sunday, December 19, 2010
ARTICLE - HOW RUMORS RULE IN HAITI
HOW RUMORS RULE IN CHOLERA-TORN HAITI
(Truthout) - By Laura Wagner
On November 12, 2010, in the bright afternoon sun in front of Ste. Catherine Hospital/CHOSCAL in Cité Soleil, where Médecins Sans Frontières has set up a cholera treatment center, a young woman staggered, keening, tears running down her face, eyes wide with shock. She was in the throes of a kriz, a crisis, a public act of grief and mourning that one displays after losing a loved one. Her child had just died in the hospital, but, she insisted, as a crowd gathered around, it was not cholera. "It was poison! Someone put poison in the water."
Cité Soleil may be an extreme example: its recent history has been particularly violent; its reputation sordid. It has been at once a particular target of international intervention and a particular case study of neglect and incompetence. But these characteristics, while more starkly illustrated in Cité Soleil, typify the broader Haitian situation. What happens in Cité Soleil should therefore be of interest not only to people who work there, but to anyone concerned with international intervention and its stigma in Haiti.
As cholera spreads in Cité Soleil, and throughout Port-au-Prince, so do rumors about its origins and transmission. While waiting to talk to an MSF representative inside CHOSCAL, my friends Damilove Gorguette and Herold Charles, who work for the DINEPA (the government water and sanitation authority) office in Cité Soleil, and I began to talk with the Haitian security guards on duty, who wore MSF or Ministry of Health vests. "It's being spread through the air," the guard in the Ministry of Health vest said. "That's not true," replied Damilove archly, handing him a packet of Aquatabs. "If that were the case, we'd all have cholera." As we talked, a new cholera case arrived, a limp man in a grey T-shirt and jeans, being carried in by three others, each of them supporting him while touching him as little as they could. His head lolled to the side, and it was hard to tell if he was conscious, though a certain tension in his body suggested he was still alive.
"It's something they've released in the water," ventured one of the MSF-vested guards.
"Who’s 'they'?" I responded.
"Those people, moun sa yo! The international community! Why do you think it's the poor who are getting it?"
"Because they have a harder time accessing clean water," I replied.
"What are you talking about? It’s the poor who take more precautions with their water than the upper classes do! No, this is something else. We grew up here, the sun kills the germs and we don"t get sick. Mikwòb pa touye ayisyen. This cholera is something else."
This proverb, mikwòb pa touye ayisyen, has been repeated a lot these last weeks. It means germs don’t kill Haitians, and I’ve heard it from residents of Cité Soleil as they gesture toward the stagnant pools of garbage-filled water, teeming with mosquito larvae, tiny fish, and blooms of green algae, that can be found throughout the Cité on the ruined lots where houses once stood.
"We were raised here, amid garbage. We grew up in it." Of course the proverb was never true; germs have always killed Haitians - especially those Haitians who don't have access to health care, adequate sanitation, or clean water. But the idea, however wrongheaded, that Haitians are particularly resistant because of their continuous exposure to unsanitary conditions, is now cited as proof that the emergence of cholera is something other than just a "germ," something outside the natural order, and something intentional.
At first, the rumors were that cholera itself was merely a rumor, a fundraising ploy. On Tuesday, November 9, as the first reports of cholera in the Cité began to surface, I encountered skepticism. "There's no cholera here," said Mirlande, who runs a small restaurant where she serves up plates of rice, beans, and okra with sauce. She waved her hand dismissively and confidently. "It's in the provinces, in the Artibonite." Even Herold, a Cité Soleil resident who, as a DINEPA employee, is charged with coordinating the distribution of free Aquatabs in the community, told me last Tuesday, "I hear things about cholera, but I can't verify it until I see it with my own eyes." But by that Friday morning, Herold had seen it with his own eyes. "We have people in the hospital now. I know two people have died," he said, while constantly squirting his hands with instant sanitizer. In three days, as the extent of the outbreak became visible and people saw cases in their own neighborhoods and camps, word on the street in Cité Soleil evolved from denial and disbelief to increasing fear and paranoia: cholera is real and was deliberately inflicted.
The most prevalent accusation is that cholera is a plot by "the NGOs" or "the international community" to profit even more from the misery of Cité Soleil's people. As Herold says, "These NGOs are mafia, they are professional thieves. They're all the same. Except Médecins Sans Frontières, because you actually see them in the community, giving free care. The rest of them are just lining their pockets."
Lucienne Estimé, one of the coordinators and residents of the camp at Place Fierté in Cité Soleil, says of the International Organization for Migration, "IOM is a cancer. A cancer is what it is for Camp Fierté! IOM has given us, nothing, nothing, nothing for the last ten months... The man who works for IOM, he doesn't need to know if your house was destroyed in the earthquake, he just says you have to return to your house. What houses can we return to?" According to Estimé, the camp has no showers. Between last Wednesday and Friday, she told me, they had had thirteen cases of cholera in the camp, some of whom have died. And cholera rumors are not limited to Cité Soleil, nor is suspicion about the intentions of international organizations. On November 16, a friend from the Port-au-Prince neighborhood of Christ-Roi told me she'd heard that the UN peacekeeping mission, MINUSTAH, had released a box of dead rats into the water in Cap Haitien with help of "the Americans." "Where did you hear that?" I asked her. "On the radio," she told me. Cholera itself may have first appeared in Cité Soleil, but rumors about its origins are spreading throughout the city. Those rumors feed on Haitians' experiences with NGOs and international aid.
Checkered Experience of International "Aid"
Cité Soleil - like much of Haiti - is an alphabet soup of NGOs and international organizations; it is no wonder that residents cannot keep them straight. Signs and murals throughout the community advertise projects funded by several acronyms in collaboration. Humanitarian, development and peacekeeping agendas become intertwined and, at least from a ground-up point-of-view, largely indistinguishable. For this reason, and because of several particularly deleterious interventions, "the NGOs" and the "international community" have all become painted with the same brush.
From November 2004 to December 2006, MINUSTAH waged an offensive in Cité Soleil in order to root out and apprehend chimères, local gang leaders believed to be supported by ex-President Aristide. This MINUSTAH "war" alienated much of the community. Some Cité residents felt loyalty to particular gang leaders, who at least provided a semblance of local governance in the absence of state-sponsored infrastructure. Moreover, while the community had suffered violence under gang rule, it suffered even more in the years of the MINUSTAH offensive. Building facades remain scarred with bullet holes; houses are still in ruins. Civilians were killed; others still bear injuries such as bullets lodged in their bodies. The young people who grew up in this setting of war and insecurity associate the UN with violence and suffering - an association that now taints MINUSTAH's more recent non-peacekeeping activities (i.e., economic and community development).
In 2007, after the most intense violence had ceased, the US Department of State, with support from Department of Defense, launched a Haiti Stabilization Initiative. USAID undertook a project of paving roads in Cité Soleil in an attempt to stimulate jobs and rehabilitate the community. Most of these projects (road and small projects) were executed by IOM. The program encompasses a security component, including re-training of local police and active gang dismantlement groups. The Embassy/USAID produced posters celebrating these roads, showing before-and-after pictures: in muted sepia tones, the photos of old muddy roads are followed by bright and sunny images of clean, paved thoroughfares. However, in several areas these roads were built higher than the homes that surrounded them, slightly convex, without adequate drainage. Cité Soleil, which is built at sea level, has always been prone to flooding; the USAID-built roads worsened this situation, so that now, when it rains, people's homes (and the abandoned lots) flood with run-off and garbage. Trash accrues and mosquitoes breed.
In 2008, with the funds from USAID/HSI, IOM built a public market in Cité Soleil to replace the main public market that had been destroyed during the years of violence. However, with no community input, IOM sited the market on a vacant tract of land directly between two zones known as "Boston" and "Brooklyn," which were competing gang territories with a history of enmity. At that time, the area was a kind of no man's land, shunned by most people because of its bad memories and the threat of ongoing violence. Also, unlike the old market, the new market was located far from the main road (Route Nationale #1) which runs by Cité Soleil (at the time, there was no Boulevard des Americains, which now cuts through the Cité), so no one from other areas of Port-au-Prince would come to the market. Apart from issues of location, the market was poorly constructed. The roof was so high that the merchants could not hang sheets to protect their wares from the sun and the rain. In the summer of 2008, the first time I visited, the public market was completely empty except for two or three people sleeping inside. A month later, the Haitian National Police ordered the merchants to use the market against their will.
In light of situations like these, Cité Soleil residents' misgivings about international organizations, and their relationship to the cholera outbreak, begin to look less like unwarranted paranoia and more like reasonable wariness, heightened by poverty and desperation. Add to this the very real possibility that cholera was introduced in Mirebalais by UN peacekeepers from Nepal (which would be the fault, not of the unwitting peacekeepers, who are but outsourced labor from another poor country, but of the MINUSTAH administration and the Haitian firms contracted to construct the sanitation facilities). The notion that cholera is something that "they" have released into the water appears less absurd.
People in Cité Soleil know full well the place that they occupy in the agendas of international organizations, as a community especially in need of aid, development, and redemption. They know that a lot of money is supposedly directed toward projects in the Cité, and yet - amid IOM-constructed basketball courts, which are not used by the local youth, a few public plazas now turned into camps, and a sea of tarps and tents from countless organizations - they see little enduring, positive change. This was the case long before the earthquake, and it is thrown into sharper relief now. They know these facts: that international organizations raise money to work in Cité Soleil; little change comes to Cité Soleil; NGO workers boast a quality of life, and a per diem, that they will never enjoy. And then they put those facts together.
How Poor Haitians Are Delegitimized
If residents of Cité Soleil distrust and sometimes hate NGOs, the feelings and gossip cut both ways. Rumors and jokes about Cité Soleil’s killers and cannibals routinely surface in casual conversation with NGO workers. Last week, a European NGO employee lightheartedly recommended that I leave some foreign visitors in Cité Soleil overnight, "then come back in the morning and pick up what’s left of them."
I made an indelicate retort before I could catch the words escaping my mouth.
After an extended - and awkward - silence, he responded sheepishly, "It's a red zone. I'm not even allowed to go there."In the eyes of the international community – and many Haitians – the whole of Cité Soleil is considered violent and criminal because of the presence and dominance of a few violent criminals. In turn, this delegitimizes Cité Soleil's residents, so that their opinions and perspectives can be discredited or ignored. Interventions are designed based on the idea that Cité Soleil residents are criminals to be feared or victims to be pitied – but rarely agents, partners or legitimate speakers about their own situation or community. Most residents of Cité Soleil are, of course, decent and normal people trying to carve out a life for themselves amid considerable hardship - and often unable to do so. And when we look at the criminal elements in the Cité - the young men who turn to guns, who turn to stealing, who turn to those who offer them a bit of power and a sense of belonging - we should remember this proverb, which people from Cité Soleil told me the first time I went there: Chen grangou pa jwe. The hungry dog doesn’t play. If you are desperate enough, poor enough, you may do anything.
Perceptions a Real Barrier
The way NGOs are perceived by a community that they are supposed to serve can be an effective - and real - obstacle to communication, both in the time of cholera and in general.
Seemingly "irrational" or "ignorant" beliefs about cholera and its origins, and about the intentions of the international community, are rooted in distrust and skepticism based on experience. One may argue that while "relativism" has its place, in this life-or-death situation, ignorance is not to be tolerated. I would argue the opposite: that the persistence and prevalence of rumor at this fatal and decisive moment illustrates the acute need to understand it. Subjective truths matter, because the supposed relationship between cholera and the international community is true to those who believe it, and therefore has a very real and powerful impact.
Laura Wagner is a PhD candidate in anthropology at UNC Chapel Hill.
(Truthout) - By Laura Wagner
On November 12, 2010, in the bright afternoon sun in front of Ste. Catherine Hospital/CHOSCAL in Cité Soleil, where Médecins Sans Frontières has set up a cholera treatment center, a young woman staggered, keening, tears running down her face, eyes wide with shock. She was in the throes of a kriz, a crisis, a public act of grief and mourning that one displays after losing a loved one. Her child had just died in the hospital, but, she insisted, as a crowd gathered around, it was not cholera. "It was poison! Someone put poison in the water."
Cité Soleil may be an extreme example: its recent history has been particularly violent; its reputation sordid. It has been at once a particular target of international intervention and a particular case study of neglect and incompetence. But these characteristics, while more starkly illustrated in Cité Soleil, typify the broader Haitian situation. What happens in Cité Soleil should therefore be of interest not only to people who work there, but to anyone concerned with international intervention and its stigma in Haiti.
As cholera spreads in Cité Soleil, and throughout Port-au-Prince, so do rumors about its origins and transmission. While waiting to talk to an MSF representative inside CHOSCAL, my friends Damilove Gorguette and Herold Charles, who work for the DINEPA (the government water and sanitation authority) office in Cité Soleil, and I began to talk with the Haitian security guards on duty, who wore MSF or Ministry of Health vests. "It's being spread through the air," the guard in the Ministry of Health vest said. "That's not true," replied Damilove archly, handing him a packet of Aquatabs. "If that were the case, we'd all have cholera." As we talked, a new cholera case arrived, a limp man in a grey T-shirt and jeans, being carried in by three others, each of them supporting him while touching him as little as they could. His head lolled to the side, and it was hard to tell if he was conscious, though a certain tension in his body suggested he was still alive.
"It's something they've released in the water," ventured one of the MSF-vested guards.
"Who’s 'they'?" I responded.
"Those people, moun sa yo! The international community! Why do you think it's the poor who are getting it?"
"Because they have a harder time accessing clean water," I replied.
"What are you talking about? It’s the poor who take more precautions with their water than the upper classes do! No, this is something else. We grew up here, the sun kills the germs and we don"t get sick. Mikwòb pa touye ayisyen. This cholera is something else."
This proverb, mikwòb pa touye ayisyen, has been repeated a lot these last weeks. It means germs don’t kill Haitians, and I’ve heard it from residents of Cité Soleil as they gesture toward the stagnant pools of garbage-filled water, teeming with mosquito larvae, tiny fish, and blooms of green algae, that can be found throughout the Cité on the ruined lots where houses once stood.
"We were raised here, amid garbage. We grew up in it." Of course the proverb was never true; germs have always killed Haitians - especially those Haitians who don't have access to health care, adequate sanitation, or clean water. But the idea, however wrongheaded, that Haitians are particularly resistant because of their continuous exposure to unsanitary conditions, is now cited as proof that the emergence of cholera is something other than just a "germ," something outside the natural order, and something intentional.
At first, the rumors were that cholera itself was merely a rumor, a fundraising ploy. On Tuesday, November 9, as the first reports of cholera in the Cité began to surface, I encountered skepticism. "There's no cholera here," said Mirlande, who runs a small restaurant where she serves up plates of rice, beans, and okra with sauce. She waved her hand dismissively and confidently. "It's in the provinces, in the Artibonite." Even Herold, a Cité Soleil resident who, as a DINEPA employee, is charged with coordinating the distribution of free Aquatabs in the community, told me last Tuesday, "I hear things about cholera, but I can't verify it until I see it with my own eyes." But by that Friday morning, Herold had seen it with his own eyes. "We have people in the hospital now. I know two people have died," he said, while constantly squirting his hands with instant sanitizer. In three days, as the extent of the outbreak became visible and people saw cases in their own neighborhoods and camps, word on the street in Cité Soleil evolved from denial and disbelief to increasing fear and paranoia: cholera is real and was deliberately inflicted.
The most prevalent accusation is that cholera is a plot by "the NGOs" or "the international community" to profit even more from the misery of Cité Soleil's people. As Herold says, "These NGOs are mafia, they are professional thieves. They're all the same. Except Médecins Sans Frontières, because you actually see them in the community, giving free care. The rest of them are just lining their pockets."
Lucienne Estimé, one of the coordinators and residents of the camp at Place Fierté in Cité Soleil, says of the International Organization for Migration, "IOM is a cancer. A cancer is what it is for Camp Fierté! IOM has given us, nothing, nothing, nothing for the last ten months... The man who works for IOM, he doesn't need to know if your house was destroyed in the earthquake, he just says you have to return to your house. What houses can we return to?" According to Estimé, the camp has no showers. Between last Wednesday and Friday, she told me, they had had thirteen cases of cholera in the camp, some of whom have died. And cholera rumors are not limited to Cité Soleil, nor is suspicion about the intentions of international organizations. On November 16, a friend from the Port-au-Prince neighborhood of Christ-Roi told me she'd heard that the UN peacekeeping mission, MINUSTAH, had released a box of dead rats into the water in Cap Haitien with help of "the Americans." "Where did you hear that?" I asked her. "On the radio," she told me. Cholera itself may have first appeared in Cité Soleil, but rumors about its origins are spreading throughout the city. Those rumors feed on Haitians' experiences with NGOs and international aid.
Checkered Experience of International "Aid"
Cité Soleil - like much of Haiti - is an alphabet soup of NGOs and international organizations; it is no wonder that residents cannot keep them straight. Signs and murals throughout the community advertise projects funded by several acronyms in collaboration. Humanitarian, development and peacekeeping agendas become intertwined and, at least from a ground-up point-of-view, largely indistinguishable. For this reason, and because of several particularly deleterious interventions, "the NGOs" and the "international community" have all become painted with the same brush.
From November 2004 to December 2006, MINUSTAH waged an offensive in Cité Soleil in order to root out and apprehend chimères, local gang leaders believed to be supported by ex-President Aristide. This MINUSTAH "war" alienated much of the community. Some Cité residents felt loyalty to particular gang leaders, who at least provided a semblance of local governance in the absence of state-sponsored infrastructure. Moreover, while the community had suffered violence under gang rule, it suffered even more in the years of the MINUSTAH offensive. Building facades remain scarred with bullet holes; houses are still in ruins. Civilians were killed; others still bear injuries such as bullets lodged in their bodies. The young people who grew up in this setting of war and insecurity associate the UN with violence and suffering - an association that now taints MINUSTAH's more recent non-peacekeeping activities (i.e., economic and community development).
In 2007, after the most intense violence had ceased, the US Department of State, with support from Department of Defense, launched a Haiti Stabilization Initiative. USAID undertook a project of paving roads in Cité Soleil in an attempt to stimulate jobs and rehabilitate the community. Most of these projects (road and small projects) were executed by IOM. The program encompasses a security component, including re-training of local police and active gang dismantlement groups. The Embassy/USAID produced posters celebrating these roads, showing before-and-after pictures: in muted sepia tones, the photos of old muddy roads are followed by bright and sunny images of clean, paved thoroughfares. However, in several areas these roads were built higher than the homes that surrounded them, slightly convex, without adequate drainage. Cité Soleil, which is built at sea level, has always been prone to flooding; the USAID-built roads worsened this situation, so that now, when it rains, people's homes (and the abandoned lots) flood with run-off and garbage. Trash accrues and mosquitoes breed.
In 2008, with the funds from USAID/HSI, IOM built a public market in Cité Soleil to replace the main public market that had been destroyed during the years of violence. However, with no community input, IOM sited the market on a vacant tract of land directly between two zones known as "Boston" and "Brooklyn," which were competing gang territories with a history of enmity. At that time, the area was a kind of no man's land, shunned by most people because of its bad memories and the threat of ongoing violence. Also, unlike the old market, the new market was located far from the main road (Route Nationale #1) which runs by Cité Soleil (at the time, there was no Boulevard des Americains, which now cuts through the Cité), so no one from other areas of Port-au-Prince would come to the market. Apart from issues of location, the market was poorly constructed. The roof was so high that the merchants could not hang sheets to protect their wares from the sun and the rain. In the summer of 2008, the first time I visited, the public market was completely empty except for two or three people sleeping inside. A month later, the Haitian National Police ordered the merchants to use the market against their will.
In light of situations like these, Cité Soleil residents' misgivings about international organizations, and their relationship to the cholera outbreak, begin to look less like unwarranted paranoia and more like reasonable wariness, heightened by poverty and desperation. Add to this the very real possibility that cholera was introduced in Mirebalais by UN peacekeepers from Nepal (which would be the fault, not of the unwitting peacekeepers, who are but outsourced labor from another poor country, but of the MINUSTAH administration and the Haitian firms contracted to construct the sanitation facilities). The notion that cholera is something that "they" have released into the water appears less absurd.
People in Cité Soleil know full well the place that they occupy in the agendas of international organizations, as a community especially in need of aid, development, and redemption. They know that a lot of money is supposedly directed toward projects in the Cité, and yet - amid IOM-constructed basketball courts, which are not used by the local youth, a few public plazas now turned into camps, and a sea of tarps and tents from countless organizations - they see little enduring, positive change. This was the case long before the earthquake, and it is thrown into sharper relief now. They know these facts: that international organizations raise money to work in Cité Soleil; little change comes to Cité Soleil; NGO workers boast a quality of life, and a per diem, that they will never enjoy. And then they put those facts together.
How Poor Haitians Are Delegitimized
If residents of Cité Soleil distrust and sometimes hate NGOs, the feelings and gossip cut both ways. Rumors and jokes about Cité Soleil’s killers and cannibals routinely surface in casual conversation with NGO workers. Last week, a European NGO employee lightheartedly recommended that I leave some foreign visitors in Cité Soleil overnight, "then come back in the morning and pick up what’s left of them."
I made an indelicate retort before I could catch the words escaping my mouth.
After an extended - and awkward - silence, he responded sheepishly, "It's a red zone. I'm not even allowed to go there."In the eyes of the international community – and many Haitians – the whole of Cité Soleil is considered violent and criminal because of the presence and dominance of a few violent criminals. In turn, this delegitimizes Cité Soleil's residents, so that their opinions and perspectives can be discredited or ignored. Interventions are designed based on the idea that Cité Soleil residents are criminals to be feared or victims to be pitied – but rarely agents, partners or legitimate speakers about their own situation or community. Most residents of Cité Soleil are, of course, decent and normal people trying to carve out a life for themselves amid considerable hardship - and often unable to do so. And when we look at the criminal elements in the Cité - the young men who turn to guns, who turn to stealing, who turn to those who offer them a bit of power and a sense of belonging - we should remember this proverb, which people from Cité Soleil told me the first time I went there: Chen grangou pa jwe. The hungry dog doesn’t play. If you are desperate enough, poor enough, you may do anything.
Perceptions a Real Barrier
The way NGOs are perceived by a community that they are supposed to serve can be an effective - and real - obstacle to communication, both in the time of cholera and in general.
Seemingly "irrational" or "ignorant" beliefs about cholera and its origins, and about the intentions of the international community, are rooted in distrust and skepticism based on experience. One may argue that while "relativism" has its place, in this life-or-death situation, ignorance is not to be tolerated. I would argue the opposite: that the persistence and prevalence of rumor at this fatal and decisive moment illustrates the acute need to understand it. Subjective truths matter, because the supposed relationship between cholera and the international community is true to those who believe it, and therefore has a very real and powerful impact.
Laura Wagner is a PhD candidate in anthropology at UNC Chapel Hill.
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