Cholera case confirmed in Dominican Republic; Haitian protestors blame U.N. peacekeeping troops for cholera outbreak

Officials on Tuesday said they had confirmed the first case of cholera in Haiti's neighbor, the Dominican Republic, the Associated Press/Forbes reports (11/16). Bautista Rojas, the Dominican health minister, said the patient is a 32-year-old Haitian construction worker who recently returned from Haiti, the BBC reports. The patient is receiving treatment in isolation in the eastern town of Higuey, Rojas said (11/16).

"The Dominican Republic had taken precautionary measures such as stepping up border controls and conducting health checks after the Pan American Health Organization issued a 'high risk' warning of cholera spreading to that country, which shares the Caribbean island of Hispanola with Haiti," RTTNews writes (11/17).

On Monday, protests erupted in Haiti among people who believe U.N. troops played a role in importing the cholera outbreak, Reuters reports. "In Haiti's second [largest] city of Cap-Haitien in the North, hundreds of protesters yelling anti-U.N. slogans hurled stones at U.N. peacekeepers, set up burning barricades and torched a police station, Haitian officials said," the news service writes. "The U.N. mission in Haiti, which is helping the poor Caribbean country rebuild after a devastating January 12 earthquake, has denied rumors that latrines close to a river at the Nepalese U.N. camp were the cause of the cholera outbreak" (Delva, 11/15).

The protests, directed at the multinational U.N. peacekeeping force, continued on Tuesday and have left two people dead, the New York Times reports. U.N. peacekeeping troops have been in the country since 2004, and "[s]ome Haitians see the peacekeepers as hard-line occupiers while others support them out of concern that the national police are unable to maintain order," the newspaper writes.

U.N. spokesman Vincent Pugliese "said the protesters were using the escalating cholera epidemic as an excuse to push the troops out and destabilize the country before the Nov. 28 presidential election," the New York Times reports. "These are not genuine demonstrations," Pugliese said, adding, "They are using spoilers paid to create chaos."

Health authorities said they are not aiming to find the cholera outbreak's origin. "We are focused on treating people, getting a handle on this and saving lives," said Daniel Epstein, a spokesman for PAHO. "Jordan Tappero, an epidemiologist with the United States Centers for Disease Control and Prevention, who is leading medical investigators in Haiti, said by telephone that it was unlikely that scientists would pinpoint where the outbreak began, and that he did not think mounting an all-out effort to find the answer 'is a good use of resources,'" according to the newspaper (Archibold, 11/17).

Also on Monday, Nigel Fisher, the U.N. humanitarian coordinator in Haiti, told reporters on a teleconference that the number of cholera cases in the country is expected to go up significantly as data collection improves, VOA News reports. Fisher also said the U.N. is working with the government to contain the outbreak and reduce fatalities.

"We expect to have, once that data comes in, a significant increase in recorded cases. So people should not be surprised at that," he said. "Fisher said emphasis is continuing on educating the public about the disease and making sure they have access to oral rehydration salts and tablets to chlorinate their water. Fisher said plans are also being made to increase the number of cholera treatment centers across the country. 'It is [cholera] spreading and we have to contain, if not [the] number of cases, we have to try to contain the number of deaths,' he said," the news service writes (Besheer, 11/15).

"Fisher confirmed that cases of the disease continued to expand rapidly, with cases reaching every department, or administrative division, as well as the capital," the U.N. News Centre writes. "This has gone far beyond a health or sanitation matter. It's an issue of environmental concern, it's an issue obviously of national security where we have demonstrations starting already, against for example cholera treatment centres," Fisher said (11/15).

"Soap could slow the terrifying cholera outbreak ... But in the squalid slums of Port-au-Prince and the river towns where the cholera outbreak began three weeks ago, many Haitians held up their hands and shook their heads, saying they had no soap to stop an infection that is spread by contaminated food and water and in which vigorous hand-washing, especially after using the toilet, is the No. 1 way to save lives," the Washington Post writes.  

"A cake of yellow Haitian soap costs about 50 cents. But many Haitians do not have soap because they cannot afford it. More than half the population lives on less than $1.25 a day," according to the newspaper (Booth, 11/16).

IRIN/PlusNews Examines Quakes' Effect On TB Control

IRIN/PlusNews examines health workers' concerns about the spread of tuberculosis in Haiti's "tent cities that have housed more than one million people since the massive earthquake in January."

"With the quake this became an emergency," said Macarthur Charles, a doctor with the Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO). "The main TB hospital, the sanatorium here in Port-au-Prince, collapsed and [the GHESKIO] hospital in Leogane [about 29km west of Port-au-Prince] for treating multi-drug resistant TB [MDR-TB] also collapsed," Charles said.

"TB is an extremely important situation because transmission is facilitated by the situation of people living under tents," said Jean William Pape, director and founder of GHESKIO.

"There is a delay in care. There is the issue of malnutrition or of having untreated HIV that allows you to have more TB, and then there's the question of you being in small areas with other people," said Megan Coffee, an infectious diseases specialist from the U.S. who has been running an expanded TB ward at Port-au-Prince's General Hospital since January.

"Shortly after the quake, health workers saw a spike in TB cases, but some think this could have been as a result of increased screening by volunteer organizations," the news service writes. "A lot of the foreigners who came to Haiti to help, they had TB on their mind, they were screening for it ... I think that drove the referrals we saw early on, and now I think we've gone down because there is less active screening," said Anany Gretchko Prosper, head of medical operations for Partners in Health.

The article also looks at concerns regarding the spread of MDR-TB and outlines the TB situation before the January earthquake (11/17).