Fear of cholera outbreak grows in Haiti's overcrowded capital

Health officials expect the disease to spread rapidly among Port-au-Prince's 3 million people


Jonathan M. Katz
November 10, 2010 3:47AM (UTC)

Health workers feared a surge of cholera cases in the shantytowns and muddy tent camps of Haiti's capital as suspected cases piled up Tuesday and a laboratory confirmed a case originated in the overcrowded city.

Hundreds of people suffered the cholera symptoms of fever and diarrhea in hospitals and shacks built along the putrid waste canals of slums like Cite Soleil and Martissant.

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At least 73 cholera cases had been confirmed among people living in Port-au-Prince. Physicians with the aid group Doctors Without Borders reported seeing more than 200 city residents with severe symptoms at their facilities alone over the last three days.

Following Monday's confirmation that a 3-year-old boy from a tent camp near Cite Soleil had contracted the disease before Oct. 31 without leaving the capital, the Pan-American Health Organization said the epidemic's spread from river towns in the countryside to the nation's primary urban center was a dangeorus development.

Damage to Port-au-Prince's already miserable pre-earthquake sanitation and drinking water systems make the city "ripe for the rapid spread of cholera," Dr. Jon K. Andrus, the organization's deputy director, told reporters Tuesday.

Port-au-Prince is estimated to be home to between 2.5 million and 3 million people, about half of whom have been living in homeless encampments since the Jan. 12 earthquake ravaged the capital.

"We expect transmission to be extensive and we have to be prepared for it, there's no question," Andrus said. "We have to prepare for a large upsurge in numbers of cases and be prepared with supplies and human resources and everything that goes into a rapid response."

A confirmed case of cholera had never been seen in this Caribbean country before last month, when it suddenly killed several dozen people and spread across the agricultural heartland of the Artibonite Valley. The U.S. Centers for Disease Control and Prevention found that the strain is most similar to those found in South Asia, but no formal investigations have been done to learn how the disease arrived in Haiti.

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It has killed more than 580 people and hospitalized more than 9,500, with confirmed cases across the entire northern two-thirds of the country. Dozens of cases are rumored throughout the south.

On Tuesday, Haiti's health ministry said the disease has become a threat to the entire nation of 10 million people.

"Now it is our duty as citizens to help solve this problem, which has gone from being an urgent humanitarian matter and gone to the level of national security," the ministry's executive director, Dr. Gabriel Timothee, said during a televised news conference.

The disease, primarily spread when infected fecal matter contaminates food or water, is preventable and treatable, mainly by rehydrating the sick with safe water or intravenous fluids and sometimes using basic antibiotics.

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But decades of failing and often regressing infrastructure -- wracked by political upheaval, unbalanced foreign trade, a 1990s embargo and natural disasters -- have left millions of Haitians without access to clean water, sanitation or medical care.

Haitian and foreign aid workers continued campaigns to tell people to wash their hands, cook food thoroughly and take other precautions against the spread of cholera. Treatment centers were being set up across the capital to handle the expected rising case load.

But health officials said that cholera will be part of the Haitian landscape for a long time, taking its place among the other challenges in one of the world's most difficult places to live.

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"We have to think about and plan for the long term," Andrus said. "The bacteria have a foothold in the rivers and the water system, so it will be there for a number of years."


Jonathan M. Katz

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