Pestel, Haiti (Photo by John Carroll)
When we had a lecture on cholera in medical school I didn’t think I would ever take care of anyone with this disease. The black and white photos of cholera patients showed some poor soul from Asia or elsewhere faraway with his gaunt cheeks and sunken eyes staring nowhere. And he was always lying on a cot with a hole cut in the middle of it.
And the medical books back then did not tie in cholera and the roles of social injustice and structural violence back then. And I doubt they do now.
But during the last 15 months I have seen more cholera than I would ever want to and I know that the medical books were not exaggerating the severity of cholera.
Cholera kills lots of people around the world. The bacteria make a toxin that causes a secretory diarrhea that causes patients to lose incredible amounts of intestinal fluid and patients go into shock. They lie in their vomit and stool and die unless they get intravenous rehydration quickly.
And now cholera is very close to home. It’s not in some far away place any more. Cholera is in Haiti.
Haiti is having more cholera per capita than any country in the world. Since October, 2010 cholera has sickened 700,000 people and killed 7,000 of them. And these are only the cases we know about.
But in Haiti cholera is a “political disease” as well. Denial, obfuscation, and lack of transparency are all part of the cholera problem too.
The UN soldiers (MINUSTAH) unknowingly brought cholera to Haiti in October, 2010. And with the help of Haitian Sanco Company, the soldiers dumped their human waste into a little river that flowed into the central river in Haiti’s breadbasket, the Artibonite Valley.
And cholera was unleashed and started to kill people quickly as they stumbled to the hospital. They often died on the road.
Like any big organization, the UN denied that they could have been the culprits. Who would want to admit they were responsible for introducing a disease that would kill thousands of Haitians? The UN was supposed to be protecting Haitians.
But the UN’s denial is not surprising.
I examined three sisters in Cite Soleil in January, 2007. MINUSTAH helicopters fired down on their house in Cite Soleil a few days before Christmas in 2006. I saw the bullet wounds in their little bodies and saw the sunlight entering through bullet holes in the roof above them in their two-story shanty. In New York, the UN denied doing this.
And with seven or eight scary gun shots I heard MINUSTAH blow the head off a guy 75 yards from me at Fr. Gerry Jean-Juste’s funeral in May 2007. The UN spokesperson said that the slain man was hit by a rock. But the soldiers’ smoking weapons could be seen from the back of their truck in video taken by a Haitian TV station.
So I guess the UN can deny introducing cholera to Haiti too.
Haitians are very afraid of cholera and very angry that cholera is here to stay for a long time.
In December 2010 there were 45 murders here in southern Haiti of natural Haitian healers who the people presumed were practicing cholera-linked witchcraft. They were blamed and summarily stoned and hacked to death before their bodies were burned in the streets.
Poor Haitians are blamed all the time for using bad hygiene and “not washing their hands” or using latrines. But the problem is they often don’t have access to either.
During the last several weeks I have lived with very poor Haitians in the mountains and I felt filthy. I didn’t take a real shower in 10 days. I was using dirty water to try to stay clean. And I was living “higher-on-the-hog” than most of the tens of thousands of Haitians surrounding me in the mountains.
Cholera is much more than just a toxic secretory diarrhea that is killing people in all of Haiti’s 10 departments. And even if we were all on the same page, cholera would be very difficult to manage here.
However Haiti’s geography is challenging, communication is poor, superstition is high, and corruption is great. Pledged money from the international community during the last two years is not coming in to Haiti, is stolen, or is not being used properly to employ Haitians and help Haitians who need it the most.
To control cholera in Haiti there needs to be a multifaceted approach set up by experts. Cholera has to be attacked from all sides. Money and organization and transparency and knowledge are all needed. And from what I have seen here on the ground, there is a long ways to go.
The rainy season is approaching quickly. And that means clean water will mix with dirty water and the incidence of cholera will increase.
Since January 1, 2012 in the Pestel Commune of southern Haiti we have documented 126 people with cholera who were put in small cholera tents or buildings and we treated them. But WHO health officials who recently came to Pestel, said that there was not a problem with cholera in Pestel.
Denial and bad statistics do not help “put the lid” on this horrible cholera epidemic.
And can you imagine trying to keep a person alive, who is losing almost all his body fluids, in a tent that is over 100 degrees F inside? I know we are not offering them good basic clinical care. And we have no idea what their electrolytes are because we have no access to point of care tests.
We don’t treat our sick animals this way in the States. Do you know any veterinarian who would put your cute pet poodle in a hot dirty tent with an IV while your dog is critically ill?
And if all of this doesn’t sound bad enough, some of the Haitian nurses staffing cholera treatment units in Pestel had not received a salary from the Haitian government since September, 2010. I would not think that would encourage their spirits. Taking good care of a sick cholera patient is difficult nursing work. But these nurses came to work anyway.
And these nurses make a grand total of 300 dollars US per month. Why were they not paid? The Haitian doctor in charge of the whole Pestel Commune was pleading that his nurses get paid.
And so we went to bat for the Haitian nurses at a “high level” and the money they were owed for the last three months was paid to them almost immediately. I wonder what the problem was?
And how about the Haitian Hospital in the village of Pestel? It is a Haitian Government hospital. And it is absolutely horrible. It is an embarrassment. There are five broken down beds serving about 80,000 people in the Pestel area. There are a couple of Haitian doctors and one Cuban doctor that staff the outpatient clinic at the hospital. The head doctor shook his head and showed me the ancient rusty green oxygen tanks that don’t function in the corner of the room where our newly admitted 58-year-old lady in florid heart failure died in front of us.
And the cholera tent is despicable at the Pestel Hospital. I don’t have adequate words to describe its filth and the misery inside of it.
And even if I had the words to describe more on the ground in Pestel, I started to have uninvited visitors at night asking me where my documented permission was that stated I could work in Pestel. And I was told my posts on the internet needed to be read by the powers that be BEFORE I posted them. And I was told NOT to take more photographs. And we were told that we could end up in jail and our vehicle could be confiscated.
So along with the poor Haitians who don’t wash their hands in clean water, the messenger in the mountains became a problem too.
With cholera in Haiti, someone always needs to be blamed.
Pestel's Mountains--Photo by John Carroll
John A. Carroll, MD
www.haitianhearts.org
Click here to see more pics from Pestel Cholera clinic: https://www.facebook.com/media/set/?set=a.300765893309504.84718.149417098444385&type=1 <Pestel Cholera Outbreak - Haiti - January 2012 By Haiti | Mphise
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