Institute for Justice and Democracy in Haiti

How Cholera Reached Haiti & How It Can Be Addressed

The following is a statement from Dr. Louise Ivers, Senior Health and Policy Advisor for Partners in Health, during a Haiti Advocacy Working Group (HAWG) panel. The panel was part of HAWG’s “Haiti Advocacy Week,” a series of events aimed at getting Haiti more attention on Capitol Hill. This particular panel focuses on the cholera epidemic and how the US government can better address it.

Dr. Louise Ivers
March 6, 2015

Cholera is a gram negative bacterial infection that is spread by contaminated water or food, and to some degree between people in households where someone is sick with symptoms. Its an ancient disease that has long been eradicated in parts of the world where simple things like clean water, latrines, soap and basic medical care are available.

In Haiti, the cholera epidemic began in October 2010 and spread with a tsunami of cases throughout the whole country within 2 months. No cases of cholera had ever been reported in Haiti before 2010, even during the Latin American epidemic of the 1990s. In fact, there is nice historical documentation of the absence of cholera cases from Hispaniola over those times.

The most dramatic volume of cases that we saw first was in the coastal city of St Marc in late October, but quickly public health specialists and health workers traced back the first cases to the town of Mirebalais in Central Haiti a week or two earlier – a town where Partners In Health works to support the Ministry of Health and where a large river crosses en route to St Marc and the ocean. Later studies would show that the cholera strain circulating in Haiti was the same strain circulating in an outbreak in Nepal, and an independent panel of experts determined that cholera had been introduced to Haiti by human activity associated with poor sanitation practices at a UN peacekeeping military base in Mirebalais.

Prevention and treatment for cholera is simple – clean water and food and hand hygiene. But both individual and public access to water, latrines and even soap is seriously limited, especially in rural Haiti and in urban slums, where few people have latrines, almost no-one has flush toilets, and families chose between buying a meal and buying soap. In addition, poor health infrastructure, poor supply chains for medication and a lack of healthcare workers made (and still makes) cholera much more difficult to prevent and treat.

What’s clear from the data is that cholera disproportionately affects poor people. Poor households have been up to 5 times more affected by cholera and 4 times more likely to die from cholera than wealthier counterparts. What is also clear is that we have effective ways to prevent, treat and eliminate cholera (including cholera vaccination as one part of the strategy), but not enough is being done.

In 2014 there were 27,388 cases of cholera, and almost 300 deaths – entirely preventable and treatable deaths from diarrhea and dehydration!!!

In the first 8 weeks of 2015, there were 7225 cases, and already 86 deaths. This is much worse than the same period of 2014 – so although we have reduced cases a lot since 2010, there is a lot of concern about continuing inability to completely control the epidemic.

US government has been a leader in the response to cholera in Haiti, and a major contributor to the reduction in cases so far – through support of the government of Haiti’s national laboratory, through surveillance, and through supporting prevention and treatment as well as clean water activities in the country – but a lot remains to be done and funding for treatment is drying up.

Since the epidemic began 4 and a half years ago, more than 730,000 Haitians have been documented to have been sick because of cholera – many more likely went unreported. 8741 people have died. – and people continue to die every week from this ridiculously-simple-to-prevent-and-treat disease.

We know what to do, and how to do it — so it’s not the time now to retreat.

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