Friday, October 25, 2013

The Cholera Outbreak In Haiti-Three Years Later

UPDATE 4-1-14: UN: Haiti has more cholera than any other nation

I find this a bit hypocritical of the UN when they are seeking immunity from the reported spread of it in 2010 by UN peacekeepers. Hopefully their initiative includes infrastructure (sanitation and hygiene) and policies that uplift the people of Haiti and protect them from this ever happening again.

"Scientific studies have shown that cholera was likely introduced in Haiti by UN peacekeepers from Nepal, where the disease is endemic.

The United Nations has claimed diplomatic immunity from class-action lawsuits being filed by lawyers representing Haitian survivors and relatives of the dead who say the UN peacekeepers contaminated Haiti's principal river with cholera-infected human waste beginning in October 2010.

In 2012, the United Nations announced a $2.27 billion initiative to help eradicate cholera in Haiti."

Also see:

Abstract: Water, Sanitation and Hygiene in Haiti: Past, Present, and Future

I can't but wonder why progress comes so slowly to countries where people of color, indigenous people and people who are poor live. You know if this had happened in the US the pace of reconstruction and restoration would be at a record pace in comparison.


Reflecting On The Cholera Outbreak In Haiti Three Years Later

By Rebecca E. Rollins/Partners In Health

Dr. Charles Patrick Almazor, from Port-au-Prince, Haiti, is director of clinical services for Zanmi Lasante, Partners In Health's sister organization in Haiti. He has worked for PIH and ZL since 2001, and was one of the doctors who saw the first cholera patients in St. Marc. He wrote the following reflection about the disease, which had never been reported in Haiti before the Oct. 19, 2010, outbreak three years ago.

Haiti is known for its torrential rains. Sometimes they begin slowly and build to a crescendo, and other times they fall suddenly and loudly and wildly. The sound of the Caribbean rain hitting your rooftop can be enjoyable and soothing if you are in a safe place—warm in your bed or lying on your sofa. The very same rains can be a nightmare for those living in flooded areas or tents. For me, the rains bring back a flood of unpleasant memories.

These memories include the hundreds of patients I saw during a past rainy season in cholera treatment centers (CTCs) in the Artibonite region of Haiti. The patients—the lucky ones who were taken to a clinic—were transported by family and community members on traditional stretchers, a straw mat on an iron bed supported by two thick sticks and carried by four men. Our patients’ eyes were sunken into their skulls, their skin as parched as the dry season. Because of their appearance, they were referred to as zombi lage, fleeing zombies. Patients of all ages laid on their cots, throwing up what they hardly found to eat, since for most of them food is a scarce resource.

I still remember a young man who was the head of his household. He was terrified of dying because he did not want to leave his family behind in dire poverty. I asked him where he lived. His wife was quick to tell me they lived in the Chaos Mountains, dramatically named for the steepness of the mountain chain. It took them six hours to walk to the hospital. Even more tragic, the patient told me he knew about the risk of cholera, but the family ran out of chlorine to treat their drinking water. His wife added that the market was closed because of the continuous rains.

When I left the CTC, the patient had already received eight liters of intravenous fluids to treat the deadly dehydration that accompanies cholera. His face had changed completely. He once again looked like a normal, living human being. I went away with the confidence he would make it.

Cholera is a good illustration of the vicious cycle of poverty and disease, in which the most vulnerable people are most likely to be victims. I’m a doctor and I have been working in Haiti for more than 10 years. This was my first exposure to such a severe diarrheal disease capable of killing so many people so quickly. On October 20, 2010, I cared for some of the first patients who came to St. Nicolas Hospital in St. Marc, Haiti, the epicenter of the cholera outbreak. It was painful to see so many patients and too few nurses and doctors.

I worked all night at the hospital with a few colleagues; we were two doctors and six nurses for more than 300 patients who needed IV fluids. We were overwhelmed by the immensity of this tragedy. Many of those 300 patients died that day. They came too late to the hospital and from too far away to be taken care of by too few providers.

Cholera is a good illustration of the vicious cycle of poverty and disease, in which the most vulnerable people are most likely to be victims. It is a water-borne disease. Haiti has been struggling to provide clean water to its citizens since its independence in 1804. Will it be feasible to do so in the next decade?

Cholera is spread through bacteria in fecal matter that contaminates water that people ingest; poor sanitation creates conditions ripe for transmission. How much time will it take before we can provide basic sanitation to the 83 percent of Haitians without latrines? It’s these questions and the lack of answers that frighten me—not the rains.

Cholera killed 5,000 Haitians in its first year. Today, three years after the outbreak, about 8,400 Haitians have died from cholera and more than 685,000 have become sick—approximately one in 15 people. The outbreak was quickly classified as the worst cholera epidemic in the world. In one year, a germ we never had was introduced into our country, followed by a disease we’d never seen. How can we protect our patients and their families from this disease? How can we protect the thousands more who live far from any health facility?

These days, it’s been raining heavily. If you are reading this, you are probably safe, warm, and dry. In Haiti, these rains put people at risk. In an ideal world, we would have a comprehensive approach for fighting cholera—preventing transmission with clean water sources, hygiene education, and latrine construction.

End of excerpt

More to this:

Cholera Introduced Into Haiti By UN Peacekeepers


The U.N. peacekeeping mission was established in 2004 to help bring security and stability to Haiti. In 2010, after a deadly earthquake, the United Nations expanded its presence in the Caribbean nation.

In trying to identify the introduction of the cholera strain, the U.N. panel’s new report tracks the arrival of a contingent of Nepalese peacekeepers from Kathmandu to a U.N. encampment in the village of Mirebalais in October 2010. Within days, hospitals in the region registered a dramatic increase in deaths from diarrhea and dehydration, signature symptoms of cholera. The illnesses marked the opening chapter in an epidemic that quickly spread across the country.

The report stated that the United Nations had constructed a “haphazard” system of pipes from the U.N. camps’ showers and toilets to six fiberglass tanks. The “black water waste,” which included human feces, was then transferred to an open, unfenced, septic pit, near where children and animals frequently roamed. The system presented “significant potential” for contamination, the report said.

The members of the U.N. panel — who no longer work for the world body — defended their initial findings, saying that the “majority of evidence” at the time of their first report was “circumstantial.”

The latest findings will increase pressure on the United Nations to acknowledge responsibility for introducing cholera into the country. U.N. Secretary General Ban Ki-moon and his top advisers had invoked the panel’s ambivalent 2010 findings in arguing that the United Nations bore no legal responsibility for the epidemic, although they said the organization was committed to lead international efforts to respond to the health crisis and improve the Haiti’s sanitation infrastructure.

The Boston-based Institute for Justice and Democracy in Haiti filed a compensation claim in November 2011 on behalf of the families of 5,000 victims, and it is preparing lawsuits against the United Nations in U.S. and Haitian courts on behalf of thousands more.


I find this to be appalling.

The fact that it happened is appalling enough. The fact so many still remain without potable water and sanitation throughout Haiti is beyond criminal. We always have billions to kill people or to finance extravagant projects based on ego. However, when it comes to truly caring for our fellow human beings we fail miserably. Shame on the UN for skirting responsibility for this epidemic.


Now it appears the strain spread in Haiti has spread to Mexico:


Haitian Cholera Strain Spreads To Mexico

A South Asian strain of cholera that was introduced into Haiti three years ago this month has now spread to this continent's mainland.

Mexico is the fourth Western Hemisphere country to experience the cholera outbreak. It's a disease that's very hard to stamp out once it gets into an area with poor water and sanitation.

Mexican health officials first picked up on the problem Sept. 9, through routine surveillance of hospital cases of severe diarrhea. Since then there have been 171 reported cases in Mexico City and states to the north and east. One victim has died.

Dr. Jon Andrus, deputy director of the Pan American Health Organization, says it was all but inevitable that cholera would spread beyond the Caribbean. "It was always a major concern that it would be exported to other countries, as has recently happened in Mexico," he tells Shots.

Since it was introduced into Haiti — very likely by United Nations peacekeeping troops from Nepal who were billeted at a camp with poor sanitary facilities — cholera has sickened 715,000 people in Haiti and the Dominican Republic (which share the island of Hispaniola) and Cuba. Nearly 9,000 have died.

Andrus fully expects it will spread further. "We are advocating throughout the region for countries to be on their guard," he says.

Cholera is thought to have invaded Cuba via infected health personnel who work in Haiti and travel back and forth. Cuba has reported nearly 700 cholera cases and three deaths, although many are skeptical that that nation is fully reporting the extent of its outbreak.

Andrus says vacationers visiting Cuba — who probably got cholera from contaminated food — have exported the disease to Chile, Venezuela, Italy, Germany and Holland. So far those cases haven't touched off outbreaks. But as the Mexican epidemic shows, it can easily happen if an imported case contaminates water or food in an area with poor sanitation.

"You have those situations throughout Latin America," he notes. "We are the region of the greatest disparities."

The last time the Americas saw a major cholera epidemic was 22 years ago. It was allegedly brought by a ship that discharged its bilge water in a Peruvian port. The disease spread all the way up the continent, sickening more than 1 million people and killing 10,000 or so, until it hit the U.S.-Mexican border. There it was stopped by modern water- and sewage-treatment facilities in the United States.

Andrus says PAHO is worried this latest epidemic will have a similar impact.

"It's really, for us, a defining moment," he says. "To what extent are we concerned about spread? Well, it's really a regional threat and now a global threat to health."

End of excerpt


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