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A half a century after Haiti’s last cholera epidemic, the deadly disease is back, mostly in areas not affected by January 2010’s deadly earthquake. With 250 dead and thousands sickened we look at what’s being done to aid the sick, to contain the disease, and to prevent the spread into the island’s capital, Port au Prince and its crowded refugee camps.
- Daniel Epstein Information Officer, Pan American Health Organization/WHO
- Joseph Guyler Delva Haiti reporter for Reuters and the BBC
MR. KOJO NNAMDIFrom WAMU 88.5 at American University in Washington, welcome to "The Kojo Nnamdi Show," connecting your neighborhood with the world. Later in the broadcast, we'll be speaking with the head of Africare. That organization has spent four decades bringing aide to Africa. But first, it's been half a century since Haiti last saw a cholera epidemic, but hurricane season has brought an unwelcome return.
MR. KOJO NNAMDIThe earthquake ravaged country is now facing a cholera outbreak 60 miles north of Port au Prince, the capital city. The deadly waterborne disease can kill in a matter of hours. With more than 150 deaths and thousands of confirmed cases, health officials fear that the fast moving epidemic will spread to the crowded camps in and around the capital where more than a million earthquake victims are living. The government health department and international aid organizations are working to treat those affected and to contain the outbreak.
MR. KOJO NNAMDIWe talk with Guyler Delva, he is the Haiti reporter for Reuters and the BBC. He joins us by telephone from Port au Prince. Guyler, thank you for joining us.
MR. JOSEPH GUYLER DELVAThank you. Thanks for having me.
NNAMDIGuyler, you have been reporting on the outbreak. Exactly where is it located?
DELVAIt is located in the Artibonite region, which is the northern part of Haiti and also in the central plateaus. Those are the two regions where you find most of the cases.
NNAMDIIt's occurring in an area that was not affected by the earthquake. Is that right? What caused it?
DELVAThey haven't found the main reason why we have that epidemic in Haiti. They don't know the source, where it came from exactly. There are speculations that it would be spread through the Artibonite River which is a big river in the Artibonite area. And of course, most of the cases have been registered, I mean, in the areas, I mean, surrounding the river. But they don't have -- they have not been able to give any specifics as to where it came from exactly.
NNAMDIWe're talking with Guyler Delva. He is the Haiti reporter for Reuters and the BBC. He joins us by telephone from Port-au-Prince. You can join the conversation if you have questions or comments by calling us at 800-433-880, by going to our website kojoshow.org or sending an e-mail to email@example.com. Guyler some infected people are traveling to the capital to get treatment. How many cases have been reported in Port-au-Prince so far?
DELVAThere are 364 cases of hospitalized in the Artibonite region and also in the central plateau. As of today, we had 259 people killed, mostly in the Artibonite area. But for now, it has stabilized a little bit in the central plateau region where you have only 14 dead and 361 people hospitalized, but the most cases are counted in the Artibonite region.
NNAMDIAnd for those cases that have been reported in the capital city of Port-au-Prince, it is my understanding that those cases originated outside of Port-au-Prince. Is that correct?
DELVAExactly. They've counted some five or seven cases in Port-au-Prince, but those are people who came from St. Marks from the Artibonite and authorities have said that they have isolated those people to make sure that they don't spread the disease and they're trying to keep it under control. So they seem worried. They are concerned that it could spread through the camps -- overcrowded camps in Port-au-Prince. And if that happens, you know, it could be a really big disaster because people are living like sardines right now. But it is not the case as of now.
NNAMDIBut I suspect there's a great deal of anxiety and fear that it will reach those camps in Port-au-Prince. It has not happened as yet, but who is in charge of organizing the response to the outbreak, Guyler?
DELVAYou have the government of Haiti through the Ministry of Health Department, but they work together hand in hand with the World Health Organization and several other international institutions. And there are several other, you know, cabinet members and departments like Interior department and several other government entities that are part of this effort.
DELVABut they work real closely with international agencies and also UN agencies, for example, the coordinator for the humanitarian effort in Haiti, Mrs. Nigel Fisher, works together -- I mean, real close with them. So it's an effort by Haitian authorities and the international community, but the entity that coordinates the whole effort is the health department.
NNAMDIGuyler, thank you very much for joining us. Guyler Delva is the Haiti reporter for Reuters and the BBC. He joined us by telephone from Port-au-Prince. Guyler, once again, thank you for joining us.
DELVAThank you, no problem.
NNAMDIJoining us now by telephone is Daniel Epstein, public information officer for PAHO the Pan American Health Organization of the World Health Organization. Daniel Epstein, thank you for joining us.
MR. DANIEL EPSTEINGood afternoon. My pleasure.
NNAMDIDan, we don't hear a lot about cholera these days. Can you remind us about the disease? How is it transmitted?
EPSTEINIt's basically a food and waterborne disease that's ingested by mouth. If you have contaminated water or contaminated food or you have been in contact with a person who has cholera and you eat something or even touch your mouth and swallow something, you can get cholera.
NNAMDIIt has to be ingested, in other words?
EPSTEINIt has to be ingested, exactly. That's the only means of transmission.
NNAMDIHow many cases are there worldwide of cholera now?
EPSTEINWorldwide, there are large numbers. It's a fairly common disease in developing countries. And I have the find the exact figure, but I know that in the Americas, for example, we had a cholera epidemic that began in Peru in 1991 and very, very quickly it spread to about 20 other countries and caused more than a million cases, with about 10,000 deaths over a period of several years. So it's not unknown. It happens very frequently. There was recently an outbreak in Zimbabwe.
EPSTEINAnd the other thing about it is that there are many people who have cholera who don't know it. It can be a-symptomatic and so therefore it can exist and it may have even existed in Haiti in prior times without it being apparent, you know, being disguised as other kinds of diarrhea or people not knowing. But it's a particularly severe form of diarrhea and causes very rapid dehydration, especially in infants. It can cause death, if not treated immediately with oral rehydration salts or intravenous rehydration.
NNAMDIIf you have questions or comments about the cholera outbreak in Haiti, you can call us at 800-433-8850 or go to our website kojoshow.org, ask a question or make a comment there. Dan, the treatment is fairly straight forward. What has to be done?
EPSTEINYou have to give the child or the person who has cholera enough water so that they can rehydrate themselves. And for this to occur, the water has to have basically salt, sugar and potassium. So we have little envelopes of oral rehydration salts which you mix with clean water and you help a person drink it slowly and that will rehydrate them and eventually kind of make the diarrhea go away.
EPSTEINIn cases where they are severely dehydrated, where it's accompanied by vomiting and severe dehydration, the oral rehydration might not be enough. You have to give them intravenous liquid and/or antibiotics to help them fight the bacteria. Then you have to keep clean afterwards. That's a basic, a very basic point. You have to make sure that people wash their hands thoroughly, drink only safe water and eat food that they know has been correctly manipulated so that it's not contaminated with cholera.
NNAMDINote to self, get thousands of envelopes from Dan before traveling to Haiti next month. Dan, the treatment may be straight forward, but it does have to be administered quickly, does it not?
EPSTEINIt has to be administered quickly, especially with small children. Infants under two years old can die very quickly if they're not rehydrated. Then diarrhea itself is one of the two major killers of children worldwide anyway, diarrhea and acute respiratory infections. And to us, it may seem like a joke, oh, someone has a bout of diarrhea, but with a child diarrhea can be severe, lead to dehydration and lead to death. And cholera is just the absolute worst case of this.
NNAMDIYour organization is working with the Haitian government on this. What's the strategy right now to contain the outbreak?
EPSTEINWe're working very closely -- we have a big presence in Haiti. We have something like 30 people there already. We've had that for a long time. So we're supporting the Ministry of Health in a couple of things. One is epidemiology, that is tracing exactly where these cases are, how they're being transmitted, where they're coming from where they're going. We're mobilizing other experts to Haiti in emergency management in water and sanitation, which is very important.
EPSTEINIn risk communication or basically public education so we can help get out radio messages and little pamphlets and information to people on how to protect themselves by washing their hands, making sure their water is disinfected, making sure the food they eat is safe and experts in case management as well. We have a big warehouse there. It's full of oral rehydration salts, IV fluids and antibiotics. Now, we're doing a needs assessment to make sure that what we have is enough and that we can procure additional needed supplies as well.
NNAMDIDan, one of the challenges is that sanitation and water are major challenges in Port-au-Prince since the earthquake.
EPSTEINThey are. They are major challenges. There were water treatment plants in Haiti previously, but they're not working well because of lack of electricity. So water production isn't enough in normal circumstances to meet the needs of the whole population. After the earthquake, our biggest problem was that many of the pipelines that carry water were destroyed and many of the roads that are used to transport water in trucks became damaged.
EPSTEINSo portable water has been really a major problem for Haiti and that's the water trucks are the major source of water in these settlements or these displaced person camps in Port-au-Prince. They're continuing to do so, so we're going to work to make sure that the water in the water trucks has been tested, vetted and thoroughly disinfected.
NNAMDIThere hasn't been an outbreak of cholera in 50 years in Haiti. What does that mean for the population's immunity?
EPSTEINIt means basically that they have none. There's no kind of heard immunity or community immunity to cholera so that people can get very severe cases. Again, the only real way to prevent it is insuring clean water and promoting good personal hygiene. Another important thing is proper disposal of bodies.
EPSTEINIf people die, you know, body fluids from cadavers can be a source of contagion. So we have to make sure to let people know that they have to dispose the bodies safely and, you know, wash their hands thoroughly, of course, immediately after that as well.
NNAMDIWhat about a vaccine?
EPSTEINThere is a vaccine for cholera, but it's complicated. It has to be given in two doses, seven days apart. And in a situation like this, we're not yet sure whether it is the right thing to do. You know, we're still evaluating that.
NNAMDIWe got an e-mail from Sonya in Miami who's asked about precautions for traveling to Haiti. Of course, we're also scheduled to leave here on the 6th to go to Haiti for a few days of broadcast.
NNAMDIBut what about precautions for traveling to Haiti?
EPSTEINI think we are advising travelers to take normal precautions that you would take in going to any developing country to ensure that you only drink bottled or boiled water. Boiling the water will kill the cholera bug. And that you eat food that you know has been cooked. In the Caribbean, they generally say, I think, if you can't boil it or peel it, don't eat it. Those might be good ground rules to use also for travelers to Haiti. And to make sure that they wash their hands frequently with soap and water.
NNAMDIAnd Fred in Fairfax, Va. says, "it seems a cholera epidemic raises health and security concerns for the U.S. What involvement do federal and other agencies have in dealing with the outbreak?
EPSTEINThe CDC, the U.S. Centers for Disease Control is very involved in working with us and with the Haitian Health Ministry as one of the main partners in working with the people affected. There are many other U.N. agencies, such as UNICEF, the MINUSTAH, the U.N. Mission in Haiti, OCHA, the CDC-HHS, et cetera. And there are lots of NGOs, there are lots of small groups, non-government organizations in Haiti that have gone on their own to help people there.
EPSTEINAnd all these people are, of course, very involved in helping us deal with this. We work together with them in something called Health Cluster, which is basically kind of a grouping of all the agencies working in health. They're having now a daily meeting to cordon the efforts, to trade information and to make sure that we work together to prevent as much death and suffering as possible in Haiti.
NNAMDIDaniel Epstein is public information officer for the Pan-American Health Organization of the World Health Organization. Dan, thank you for joining us.
EPSTEINAll right. Thank you.
NNAMDIWe're going to take a short break. When we come back, our conversation with the CEO of Africare, which has been doing development work in Africa for the past 40 years. I'm Kojo Nnamdi.
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