By. John A. Car­roll, MD, pjstar.com

(Author’s Note: This arti­cle was very hard for me to write. My goal was to describe chal­lenges on the ground “fight­ing the war on cholera” in rural Haiti. I also wanted to empha­size that to “win this war” we have to iden­tify and try to min­i­mize the polit­i­cal agen­das regard­ing cholera. Cholera is much more than iden­ti­fy­ing dirty water sources, pass­ing out aquatabs, pro­vid­ing oral rehy­dra­tion solu­tion, tents, and IV flu­ids. Only if trans­parency and hon­esty at all lev­els are added to tra­di­tional mod­ern cholera care, do the poor Haitians in the moun­tains have a chance against this dis­ease. It is up to us. jc)

When I stud­ied cholera in med­ical school I didn’t think I would ever take care of any­one with this dis­ease. The black and white pho­tos in med­ical books of cholera patients always seemed to show some poor soul from Asia or some­where far­away with his gaunt cheeks and sunken eyes star­ing nowhere.

And the med­ical books back then did not link 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 now that my old med­ical books were not exag­ger­at­ing what cholera does to a person.

Cholera kills lots of peo­ple around the world. The cholera bac­te­ria makes a toxin that pro­duces a secre­tory diar­rhea that causes patients to lose incred­i­ble amounts of intesti­nal fluid and slip 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 has 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. Many more have died uncounted in the moun­tains of Haiti where about 60% of Haitians live.

Cholera is much more than just a toxic diar­rhea that is killing peo­ple in all of Haiti’s 10 depart­ments. There is much more involved.

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 all too often never mak­ing it to the com­mu­ni­ties in Haiti with the great­est risk of cholera. It 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 but engag­ing local cit­i­zens to carry out some of the most impor­tant life-critical func­tions. Cholera has to be attacked from all sides. Expert knowl­edge, orga­ni­za­tion, money, and trans­parency 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 we treated in small cholera tents or build­ings set up in four moun­tain villages.

But Pan-American Health Orga­ni­za­tion (PAHO) 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. You see cholera is a “polit­i­cal dis­ease” here and obfus­ca­tion and lack of trans­parency are all part of the problem.

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 in our make shift cholera tents. But it is all the rural Haitians have and it is the best we can do right now.

And we all like to place the “blame of cholera” on some­one else.

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.

Cholera was unleashed and started to kill peo­ple quickly as they stum­bled or were car­ried to the hos­pi­tal. Many patients did not make it to the hos­pi­tal and 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.

Haitians are very afraid of cholera and are very angry that cholera is here to stay.

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.

And 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 of Pes­tel and I felt filthy. I didn’t take a real shower in 10 days. But I had fairly clean water to drink…which is a lux­ury that tens of thou­sands of Haitians sur­round­ing me in the moun­tains do not have.

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, 2011. I would not think that would encour­age their spir­its. But these nurses came to work any­way. Tak­ing good care of a sick cholera patient is dif­fi­cult nurs­ing work.

And these Hait­ian 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 salaries they were owed for the last three months were 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 “ade­quate words” to describe the mis­ery 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.

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.

Photo is taken By.  John Car­roll — Eighty year old Cholera Patient, Pestel, Haiti.
See The Orig­i­nal Post : http://blogs.pjstar.com/haiti/2012/01/27/cholera-and-blame-in-rural-haiti/
If you want to learn more about the author, please visit : http://www.haitianhearts.org/index.html