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The Pan-American Health Organization (PAHO) reports (PDF) as of 1800 yesterday, 24 October 2010, there have been 253 deaths from cholera and 3015 confirmed cases. This represents a crude mortality rate 11.92%. Cholera treated promptly has a mortality rate of 1-2%. According to PAHO, 46% of deaths have been in the hospital setting, the balance in the community. Twelve cholera treatment centres are being built in strategic points, in the Artibonite and Centre regions, as well as in Port-au-Prince.
According to the Partners in Health (PIH) Twitter stream, the identified cholera patients in Port-au-Prince came from the areas already infected. This might be considered reassuring. At l’hôpital St-Nicholas in St-Marc, 600 patients were triaged. If you work in a Canadian or American ED, you can appreciate how overwhelming that number is. Médicins sans frontières has set up two triage streams at the hospital, for cholera cases, and all other patients. PIH is also tweeting that 10 cases have been reported in Gonaïves, largest city in Haiti’s Artibonite region. In general, reports of cases are moving southwards and inland.
Some notes on the scandal of water in Haiti
Access to clean water, considered a basic human right by the United Nations, has been severely hindered in Haiti, including the Artibonite region, because of the foreign policy of the Clinton administration, which blocked loans to improve the country’s water supply. According to PIH:
In 1998, the Inter-American Development Bank (IDB) awarded $54 million in loans to the Haitian government to improve the country’s patchwork, crumbling public-water system. The money was intended to bring clean water to people who for many years had been denied this basic human right, with devastating consequences for public health. Ten years later, however, this desperately needed money has not produced a single improvement to Haiti’s water supply in the city designated to be one of the first recipients.
[T]he United States government’s clandestine efforts to ensure that political considerations (namely the desire to destabilize Haiti’s elected government at that time, led by President Jean-Bertrand Aristide) took precedence over the rights of some of the planet’s poorest and most vulnerable people.
[snip]
Internal documents from the U.S. Treasury Department and the office of the U.S. Executive Director at the IDB, obtained through Freedom of Information Act requests, show that officials actively used American influence to block the loans in an attempt to destabilize the government led by President Aristide, who was ultimately overthrown in 2004.
Joia Mukherjee, Chief Medical Officer PIH, explains how this political interference, coupled with natural disasters and environmental degradation, made the current outbreak of cholera almost inevitable:
The city of St. Marc (population 220,000) and region of the lower Artibonite (population 600,000) were among the areas slated for upgrading of the public water supply. This project was delayed more than a decade and has not yet been completed. We believe secure and free access to clean water is a basic human right that should be delivered through the public sector and that the international community’s failure to assist the government of Haiti in developing a safe water supply has been violation of this basic right. Additionally, in Gonaives the capital of the Artibonite has been destroyed in two waves of floods and mudslides, after tropical storm Jeanne in 2004 and after the series of hurricanes in 2008, made possible because of the environmental devastation of the region. The destruction contaminated the water supply and left the infrastructure (including the health infrastructure) of the upper Artibonite in ruins, forcing people to seek residence and medical care in St. Marc. The St. Marc region itself experienced significant flooding in 2008, displacing thousands of people. Lastly, the earthquake of January 12, 2010 resulted in the displacement of 1.7 million Haitians. While reliable statistics are not available currently, the last estimate, as of March of 2010 was that 300,000 addition Haitians had fled Port au Prince to the Artibonite. As there are no “camps” in the region, these displaced persons are “home hosted”—joining poor relatives in already overcrowded conditions, without water security or adequate sanitation.
If there ever was a sign where evil hits the road, it would be here.
Media reports on the epidemic here.
Another great resource: Haiti: Operational Biosurveillance. (Twitter)
On the ground, good sources of information and of course needing donations:
My wife and I visited Haiti over thirty years ago. One evening, while in Porte au Prince, we visited a medical clinic. During our stay, there was one of those tropical downpours which last about half an hour.
As we climbed down the hill to the street, the nuns who ran the place told us to watch our step. There was no indoor plumbing in the corrugated shacks which surrounded us. So people dumped the contents of the buckets which served as toilets onto the path; and when the rains came, the stuff washed down into the streets.
A kind of urban slough had formed where the path met the street, and a young girl was bathing in it. That image has stayed with me ever since.