PORT-AU-PRINCE, Haiti– As a diarrheal disease, cholera results in nearly 130,000 deaths a year in both epidemic and endemic settings. This disease affects children in more than 51 countries in Asia and sub-Saharan Africa. The Bill and Melinda Gates Foundation report recent epidemics in Zimbabwe, Haiti, Guinea and Sierra Leone. The previously under-resourced health facilities strain to meet the growing demand, and patients continue to die without access to treatment.
Though preventable and treatable, these epidemics continue to occur in developing countries. The burden falls predominantly on lower income and marginalized populations for a number of reasons: additional health issues, insufficient micro-nutrients, contaminated water sources and unsanitary living conditions in urban neighborhoods.
The 2010 earthquake in Haiti devastated the infrastructure and national economy, yet cholera serves as a far more insidious and persistent enemy to this country. Haiti had not faced cholera in more than century, but the initial cases originated from a United Nations peacekeeping camp.
Daniele Lantagne, an environmental engineer at Tufts University, refers to the cholera strain in Nepal as an “exact match” to the strain in Haiti. Scientists reached a consensus: Nepalese soldiers at the UN camp unknowingly infected Haiti people with the disease. Sewage, downstream from the camp, contaminated a local river.
In the first few days of the epidemic, a nearby hospital admitted a new patient every 3.5 minutes. With no immunity to the disease, Lantagne compared its threat to “when Europeans brought smallpox to the Americas, and it burned through the native populations.”
As the memory of the 2009 earthquake fades from public memory, cholera endures. Today, it claimed more than 8,500 lives and infected hundred of thousands. Haiti received an estimated $9 million in foreign aid, yet the sanitation remains poor.
The country has no sewers. Rather, it depends on bayakou, independent workers who clean the latrines by hand. These men “climb into the latrines with a bucket…and scoop out the excrement,” reports journalist Jonathan Katz. However, bayakou only serve the wealthier Haitians. These men and women can afford the luxury cesspool beneath their latrines. Most rely on open fields or canals to defecate. Unable to reach these preferred locations, people use a “flying toilet.”
“You take a plastic bag. You go in the plastic bag. And then you throw it,” he elaborates.
Immediately following the earthquake, foreign aid provided temporary toilets and safe water, yet this aid provided short-term relief without long-term protection. Poor sanitation initially led to the spread of this bacteria, as the UN base failed to contain the contamination. Moreover, the subsequent “band-aid” solutions resulted in a rising prevalence of cholera in Haiti.
Vaccinations also serve as immediate relief. To enact lasting reform, though, the UN and other governments should educate local health workers on sanitation. Facing the economic devastation of the earthquake and cholera, Haiti would benefit greatly from locally-driven interventions. This ensures a continued effort to protect citizens’ health, following the withdrawal of relief workers.
The most durable solution? Sewers. Reporting on Haiti for years, Katz has become an advocate for building underground pipes. Aid should equip residents with the tools to protect their health in the long-term. Rebuilding the collapsed infrastructure promises lasting relief, returning Haiti to the road of economic recovery.