Haiti dodged a bullet when Tropical Storm Tomas, once a hurricane, did minimal damage to the country's earthquake-ravaged capital of Port-au-Prince, where 1.5 million people are still homeless after the Jan. 12, 2010, cataclysm; in the outlying provinces, eight people were killed. But another storm, invisible to weather radar, may now be gaining strength: cholera.
"With all the inundation and consequences of the hurricane, the [populace] can become more vulnerable. There are more and more people [ingesting] cholera [through contaminated water]. We must prepare ourselves for the worst," says Dr. Claude Surena, a consultant for the Ministry of Public Health and Population. Surena's ministry first confirmed an outbreak of cholera on Oct. 20 in the bucolic Artibonite region, just north of the capital. Since then, there have been more than 7,700 confirmed cases in the country and at least 500 deaths, according to figures released on Nov. 5. Confirmed cholera cases rose 60% just this past week, ahead of Tomas' feared arrival.
Cholera spreads when people consume water or food that has been contaminated with fecal matter containing the bacteria. The contagion causes severe diarrhea and vomiting, which leads to serious dehydration and organ failure.
As Tomas' rains swept through Haiti, anecdotal evidence mounted regarding conditions that could lead to cholera's spread. In the Port-au-Prince district of Delmas 33, canals came close to flooding the fraying blue tents of a camp for people made homeless by the earthquake. The only reason no flooding occurred was that a group of men stood in the canal's murky water, picking up piles of trash with their bare hands to keep the waterway from clogging and overflowing. "We as a community had to band together to clean out the canals ourselves," says Renauld Pollicard, a camp dweller. "A lot of people are scared of getting cholera, so we had to pay those men. Otherwise, no one would go down in that hole." This does not mean, however, that the men who worked the canals were not infected. Or that other areas were not deluged with infected water.
While there have been no confirmed cases in Port-au-Prince, people suffering from cholera who have been through Artibonite have been hospitalized in the capital. It is feared that flooding in southern regions like Léogâne poses an increasing risk of the bacteria contaminating more water sources. About 80% of those infected with cholera do not show symptoms but can still pass on the bacteria and infect others.
"This certainly right now is an epidemic," says Dr. Jordan Tappero, an epidemiologist and Haiti team leader for the U.S. Centers for Disease Control and Prevention (CDC). "We have to keep a mind-set that cholera is likely to spread across the county due to poor sanitation and lack of potable water."
Haiti has not had an outbreak of cholera in a century, and the source of the contamination remains a mystery. The CDC says that cholera in Haiti matches strains commonly found in South Asia. This news intensified concerns that a U.N. base housing Nepalese peacekeepers in Artibonite was the source. The CDC, the World Health Organization and the U.N. are no longer pursuing the investigation of the source. "We know that cholera is a hitchhiker," adds Tappero. "Trying to figure out who brought it into the country is almost impossible."
But some experts disagree and say the source should be identified to track the spread of the disease. Some are even calling the termination of the investigation politically motivated. The U.N. peacekeepers, who operate under Minustah, the French acronym for the U.N. Stabilization Mission in Haiti, are unpopular in the country; an anti-Minustah protest sprang up last week even before the CDC confirmed that the strain had links to South Asia.
The government has been trying to allay the xenophobia. "We know that it came from South Asia, but anyone who has taken a plane could have traveled anywhere in the world and brought it here," says Haitian Prime Minister Jean-Max Bellerive. "It's not a question of who brought it into the country. Let's eradicate it."
In an effort to combat the spread of the disease, the Health Ministry has been running radio announcements instructing citizens on hygienic practices, including frequent hand-washing. The World Health Organization's Global Health Cluster, a grouping of international health NGOs, says the capital now has seven cholera-treatment centers, which can care for about 1,000 patients combined. In addition, 14 private hospitals, each with a capacity for 10 to 20 patients, have been designated to house people infected and suffering from cholera.