Haiti’s Unstoppable Outbreak

In early February, when Jenniflore Abelard arrived at her parents’ house high in the hills of Port-au-Prince, Haiti, her father Johnson was home. (Some names have been changed to protect the privacy of patients and family members.) He was lying in the yard, under a tree, vomiting. When Jenniflore spoke to him, his responses, between retches, sounded strange: “nasal, like his voice was coming out of his nose.” He talked “like a zombie.” This is a powerful image to use in Haiti, where voodoo is practiced and where the supernatural doesn’t seem as far-fetched as it might elsewhere. Her father’s eyes were sunk back into his head. She was shocked, but she knew what this was, because she has lived through the past five years in Haiti. She has lived through the time of kolera.

On October 18, 2010, Cuban medical brigades working in the areas around the town of Mirebalais in Haiti reported a worrying increase in patients with acute, watery diarrhea and vomiting. There had been 61 cases the previous week, and on October 18 alone there were 28 new admissions and two deaths.

That was the beginning. Five years on, cholera has killed nearly 9,000 Haitians. More than 730,000 people have been infected. It is the worst outbreak of the disease, globally, in modern history. Hundreds of emergency and development workers have been working alongside the Haitian government for five years, trying to rid the country of cholera, and millions of dollars have been dispensed in the fight to eradicate it. But it’s still here. Why?

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In 1884, the scientist Robert Koch sent a dispatch from Calcutta to the German Interior Ministry about the bacterium that he had been studying. It was “a little bent, like a comma,” he wrote. He was sure that this organism was causing the cholera that had been ravaging the world since 1817, when it laid waste to Bengal. Its onslaught there was shocking, even for a region that had had cholera—or something similar—for so long that there was a specific cholera goddess, Ola Beebee (translated as “our Lady of the Flux.”)

Ola Beebee was meant to protect against this mysterious affliction, which terrified people. Who would not be scared by seeing “the lips blue, the face haggard, the eyes hollow, the stomach sunk in, the limbs contracted and crumpled as if by fire?” Although 1817 is the official starting date of the first cholera pandemic, humans and cholera have almost certainly coexisted for far longer: That description of cholera’s distinct symptoms was inscribed on a temple in Gujarat, India, over 2,000 years ago.

information from the WHO. Hispaniola, the island where Haiti is situated, is circled. (Parkin Parkin / Mosaic)

Four hours’ drive from Port-au-Prince (it should be two, but it takes two hours to escape the city’s atrocious traffic), I get into a white four-wheel drive vehicle belonging to Action Contre La Faim, a French NGO that is a local implementing partner for UNICEF (one of the major actors in Haiti throughout the epidemic) and also the host of my trip. I’m nervous: This will be my first encounter with cholera patients, and with a CTC. What if the place stinks? How should I react? I don’t have long to think about this because the first visit is to the CTC in Gonaïves, the departmental capital, only a few minutes’ drive from the Action Contre La Faim compound.

It’s a small structure behind a blood bank, located in a yard near a toilet block that includes one stall marked “Cholera Patients” and another marked “Tuberculosis.” Before I can enter, I must be chlorinated: hands, first, then I press my shoes onto a chlorine-soaked mat. (“Chlorine is our best friend,” I’m told in another CTC by a smiling clinic worker.) Inside, the small clinic is rudimentary but clean. There are four patients in the treatment area: A young man sitting on his bed, an older woman lying on hers, and two children, including 5-year-old Junior, whose eyes are shut and whose bottom is naked. He looks weak and sick.

The ward doesn’t smell, although each patient is lying on a cholera cot, a special bed that has a hole cut out of the canvas and a bucket underneath to catch what in Creole is called dlo diri (from de l’eau de riz, “rice-water”), the watery diarrhea that pours out of cholera patients. When I show images of these cots to friends, they are shocked at the indignity. But there is no dignity when you are expelling dlo diri. A hole and a bucket are comforts, along with either oral rehydration solution or an IV drip with glucose and electrolytes. A patient’s precise treatment depends on whether they are classed as Plan A (observation and rehydration with oral rehydration solution), Plan B (rehydration and possibly an IV drip) or Plan C (definitely an IV drip).