Cholera hits Haiti again

By Dr. Ananya Mandal, MDJul 24 2011

Cholera the bacterial disease that rapidly leads to diarrhea and dehydration and kills millions worldwide ravaged Haiti last fall and has spread quickly to all regions of the Caribbean country. With the rainy season now in progress, clinics across the country are again bustling with seriously ill patients.

“We are still in … an epidemic,” said Jocelyne Pierre Louis, spokeswoman for the government Ministry of Public Health. The department reports deaths of more than 5,800 people since the epidemic began in October. It adds that 363,000 people have contracted the disease till date. Many health workers believe the number is higher. Uncounted victims have died in remote areas of the country, never reaching services and never being added to government tallies. The Health Ministry reported more than 1,000 new cholera cases a day last month.

One of the key measures for prevention is good sanitation. Spread through contaminated water in a country with no central sewage or potable water systems, cholera remains a formidable threat. Romain Gitenet, head of the Haiti mission for France-based Doctors Without Borders, which has opened cholera treatment centers across the country said, “If we want to make cholera disappear, it will be with water and sanitation,” said.

Epidemiologists with the U.S. Centers for Disease Control and Prevention have cited a United Nations base housing Nepalese peacekeepers in the rural town of Mirebalais as the likely source of the epidemic. Cholera is prevalent in Nepal, a South Asian country. But the U.N. maintains that a “confluence of factors” led to the outbreak. Government programs and private non-profit health organizations have mounted a vigorous campaign, distributing chlorine and educating people on prevention and treatment, in an attempt to slow the spread of the disease.

According to experts this second wave is less deadly because more people recognize cholera symptoms, vomiting and diarrhea, and know to seek treatment quickly. Louis added that programs to equip communities with cisterns of clean water or cholera clinics did not address the causes. “The problem of sanitation can't be dealt with between today and tomorrow,” Jocelyne Pierre Louis said.

“This is a pattern that we might see, quite literally, every rainy season,’’ said Dr. David Walton, a physician at Brigham and Women’s Hospital who has been traveling to Haiti for more than a decade with Partners in Health. “Educational campaigns only go so far.’’