The death toll from Haiti's cholera epidemic has risen to at least 4,030 more than three months after the disease broke out in the country's Artibonite Valley, the health ministry said.
The number of cholera cases in Haiti totalled 209,034 as of January 24, the ministry said.
The severity of the epidemic has diminished over time, but the ministry's figures show that Haitians are still dying from the bacterial infection, which can strike swiftly with intense diarrhoea and vomiting leading to dehydration and sometimes death.
In the latest twist in the evolution of the epidemic, Haitian and international health officials are investigating a cluster of cases of paralysis in recovering cholera patients within days of them being discharged from a treatment centre.
"Experts, including toxicologists, are investigating possible contamination at a hospital or at home from medication, food, or another source as the cause of death in these cases," the Pan American Health Organisation said.
Another possible cause is polio, it said, but officials believe that is highly unlikely because polio is rarely lethal and three of the four patients who suffered paralysis died.
The health crisis broke out in mid-October as Haiti was struggling to recover from a 7.0-magnitude quake that killed more than 220,000 people, left 1.3 million homeless, and the capital in ruins.
While the epidemic is subsiding in Haiti, Venezuelan authorities announced emergency measures on Thursday after 452 Venezuelans were exposed to cholera at a wedding on Saturday in the Dominican Republic, which borders Haiti.
There were at least 37 confirmed cholera cases among Venezuelans returning from the wedding, and officials in Caracas were trying to track down more than 400 others known to have attended the event.
An elderly cholera victim is transferred from Villard to Saint-Marc, the epicentre of Haiti's cholera outbreak where thousands have been treated.
(Toronto Star) - By Jennifer Wells
DROUIN -At 6:15 on a weekday morning Lovely Avelus is not yet in her cherry red school attire, but rather the pale brown dress in which she slept.
An adolescent boy named Venecen — a shy recent addition to the family compound — carries her past the one-bunny rabbit cage to a semi-hidden patch of ground in order to provide some privacy for her morning toilet.
After a long, patient wait, Venecen tears a piece of frond from a plantain tree and hands it to Lovely so she may clean her bottom. Then off she scampers to continue playing peek-a-boo behind the curtain of her one-room home, which is dank and cold on this morning.
In the lone bed in this single room lies Lina, the 25-year-old daughter of Lovely’s uncle, Delius Elistin. Lina, who has a wet, rattling cough, gave birth to a baby boy two days before. She has not yet received any medical care.
It is simply too much.
Here in the land of earthquakes and here in the land of hurricanes and here in the land of abject poverty, Lovely’s family can now claim residence here in the land of cholera where, as of Friday, 330 have died and 4,714 cases have been confirmed.
Lovely’s extended family, none of whom has experienced an outbreak before, has some notion of what it means to play host to the latest disease to colonize Haiti. “We put two or three drops of bleach,” says Elistin, when asked what preventive treatments are applied to the water drawn from a nearby cistern. “We’re not putting much.”
Elistin says he has heard radio advisories recommending that the onset of diarrhea be treated by adding lemon juice to the water. It is true that lemon lowers the ph of water, thus making it an effective disinfectant against vibrio cholerae. If only it were so simple. “These days we cannot find lemons,” he says of his recent market searches. It’s hardly lemon weather.
Lovely’s mother, Rosemene, is cleaning out a small plastic container with a leaf. She is asked what special precautions she takes in preparing food, to which she responds that she washes the lettuce before consumption.
At Lovely’s home in Fermathe, at some remove from the squalor of the tent cities of Port-au-Prince, messages of prevention are half received and only partially executed. The U.S. Centers for Disease Control advises eight drops of bleach per gallon of water, which must be stored in clean, covered containers. Wash your hands after defecating is a steady reminder throughout the country. Lettuce? Verboten. “Boil it, cook it, peel it, or leave it,” is a simple CDC catchphrase which authorities here would do well to adopt.
It is as if the family lies in wait, just as the world lies in wait. Will the epidemic catch in the capital among the more than one million displaced in the fetid tent cities?
Cholera plays no obvious game. There are no stated rules.
It pops up one day in Drouin, and then Villard. And now there’s Petite Rivière and unconfirmed reports in Arcahaie. It is as if the epidemic were toying with the international and Haitian health communities, as if the bacteria too were playing a grim version of peek-a-boo.
It is unwise to think one has seen the worst of Haiti, or to imagine I had seen the worst of Haiti.
To observe the cholera outbreak in its full deathly flourish, one must travel to the Artibonite lowland, and so we chose the coastal route north from Port-au-Prince to Saint-Marc and from there northeast to Pont Sondé where the highway meets the Artibonite River. With luck, if the rains held, we would trace the river’s journey from Pont Sondé north again to Villard and then west to Drouin and on to Grande Saline where the Artibonite empties into the Gulf of Gonaives.
The coastal highway is often treacherous, not so much due to the state of the road, which is quite good, at least as far as Pont Sondé, but the quality of the driving. We observed four accidents on our way. The legless body of a trucker lies supine on the road, innards spilling outward, his head wrapped in a ragged bit of blue cloth, someone’s effort at a makeshift bandage.
At Pont Sondé it is market day and it is madness. Throngs of what must be thousands: farmers who have brought their haulage of sweet potatoes; women tending sacks of Haitian rice; split-open storage bags heaping with pyramids of rough salt brought from the coast. The fresh produce, agricultural bounty, is brought in by the tonnage and shipped out to larger cities: Gonaives to the north; Port-au-Prince to the south.
Across the span of the bridge, a serious line of women hustlers sells dry goods: ribbons and sparkly sandals and cosmetics. Below lies the river.
The river. The Artibonite is a historic irrigation artery for the country, albeit one that was dammed in the far east of the country by the U.S. in 1956, flooding part of the central plateau and displacing farmers there.
Here in the lowland — so rare in such a mountainous country — rice fields spread out square upon square, as if someone kicked a giant coil of sod and it rolled itself out to carpet the land.
The rains this season have been flooding and relentless. The area has been more or less under water since July, informs one aid worker. Women have come through deep water to get to market early.
The invasion of cheap, white American rice has economically devastated the rice farmers. Still, impoverished Haitian workers migrate here during the rice harvest, eager even for the 125 gourdes a day pay.
On Monday, as the death toll rose to 259 and the number of cases to 3,342, the United Nations Office for the Co-Ordination of Humanitarian Affairs echoed Haitian health ministry officials in citing cholera’s toll among the poorest of the poor. “Assessments show the majority of cases involve people from rural areas where rice growing is prevalent,” said the OCHA in a release.
Many deaths have been seasonal labourers. How ironic that doctors informing ill patients of the trademark characteristics of cholera describe the bacterial-ridden stool of victims as emerging “like rice water.”
Not all the victims are farm workers. Beyond Pont Sondé, just before the village of Villard, Maculèz Axelis dusts her aged feet though her small amount of un-hulled rice that she sells by the road. Her 14-year-old niece, Ti Madanm, died last night. She says the villagers have been asking that at least a clinic be built. If their requests had been heard, she says, the children would not have died. Simple rehydration salts often work wonders.
From the blacktop road at Villard, the journey turns to rougher stone and very quickly time evaporates. “Blanc!” cries a young boy outside a collection of the tin-roofed mud and straw huts that the rice farmers call home. That would be me, blanc. The outsider. Bonjour, blanc.
The villages spread either side of the Artibonite, which flows not more than 10 feet from the road. Great patches of drying rice trim the road: on one side the river, and on the other the rice.
Forty minutes later we arrive at the clinic at Drouin, serving the region of Grande Saline — with a population of about 45,000 — and the same named village that anchors it. The clinic was hit hard by the outbreak a week ago. “It was chaos. There were bodies everywhere,” says Dr. Rashid al Badi, who leads the clinical day shift.
Al Badi is wearing a red Humedica vest. The German aid agency is working in concert with a team of Cuban doctors. There are two tiny cholera victims hooked to IVs a few feet away. By midweek the clinic had recorded 40 deaths. I tell him I have heard that a patient passed away moments ago.
“He came alone,” al Badi says.
The patient was rehydrated. A single dose of the antibiotic Doxycycline was administered. “He was fully hydrated, we were trying really hard,” says al Badi. “Late morning he went into cardiac arrest.” Attempts at resuscitation failed.
He estimates the patient’s age at about 30, but who knows?
“The villagers didn’t recognize him.”
Perhaps he was a seasonal worker. “They are drinking water from the river directly,” al Badi informs. Of course they are. They have for centuries.
“Even after death we don’t know who to contact. We’re waiting for someone to come.”
On a narrow passageway between the clinic and a cement wall, the body of the unknown cholera victim has been placed. On this day, Wednesday, the death count will rise to 284.
The body has been covered with a blue tarp. Small thin pieces of wood have been placed on the edges of the tarp. The winds in the late afternoon can get quite spirited. I wonder if the wood will be blown away.
When the winds come up the rains cannot be far behind.
The village of Grande Saline cannot be reached, we are told. Access is flooded. Boats have been used to retrieve the ill. And a helicopter. And so, as they say in Creole, “nou fè bak.”
In doing so we trace the journey of the stricken seeking medical care to the road back to Villard where it meets the highway, returning via Saint-Marc and on to Port-au-Prince.
It’s a mistake to become oblivious to the noise and chaos and horn blaring. The Toyota pickup on our tail appeared to be any other impatient Haitian, the words “Merci Jesus” painted on the front of his truck. He was in a great hurry. Isn’t everyone? Until I noted a hand holding an IV bag rising from the back of the truck, and let the truck pass and studied the despairing look of a young man keeping the arm of a limp old man aloft, the old man’s lean form spread across two laps in the back of the pickup.
The truck pulled up to Saint Nicolas Hospital in Saint-Marc. Earlier in the day I had revisited the clinic, my third trip in. By Wednesday at the latest a cholera treatment centre was supposed to be in place, taking the victims out of the general hospital population.
“But they had to stop construction because people didn’t want them to build this centre near their homes,” says Dr. Mayette Yfto, the hospital’s chief administrator. He’s very polite, Dr. Yfto. The locals threatened to burn the thing down.
Instead the centre will be constructed in Pont Sondé.
The good news: the number of admissions at Saint Nicolas has slowed, says Patrick Almazor, the Partners in Health director for the Artibonite region. PIH has had a long-term working alliance at Saint Nicolas and its doctors and nurses have been key to handling the crisis. Sixty-five deaths have been recorded at the hospital. More than half of those victims died before being carried through the hospital gate.
On Tuesday, Almazor saw a body on the road to Petite Rivière. “After three or four days they dump them into the river,” he says. The nameless ones.
From Saint-Marc the medical geography of Haiti’s cholera epidemic splits in two.
On Thursday, there were reports of 174 cases further south along the coastal highway at Arcahaie. The name may mean little today but there was a time when the beach strip from, roughly, Montrouis to Arcahaie featured a Club Med and other Caribbean-style getaways and there was a time when a cholera epidemic in Haiti would have been measured in lost dollars in tourism and trade.
No more. The local news reports the small street vendors are suffering some.
On the northern side of the mountains that split the lowlands from the coast, cases have been reported at Verettes and Mirebalais.
For more than a week the mayor of Mirebalais has blamed the deaths in his community on a Nepalese-staffed United Nations base situated on the Meille River, a tributary of the Artibonite.
The UN has repeatedly insisted that none of the 700 on base has tested positive for cholera and that suggestions in some media reports that uncontained excrement has leeched from latrines are not true. The seepage, says UN spokesperson Vincenzo Pugliese, can be sourced to overflowing “soak pits” containing shower and kitchen waters.
“For sure it’s about migration. For sure,” says Mayette Yfto, meaning that the epidemic has been imported from lands abroad. It is as if Haiti is desperate to prove that this one horror, this one catastrophe, is not of its own making.
There may never be an absolute answer. Even genetic markers may ultimately fail to prove the epidemic’s source.
In a news conference Friday, Gabriel Timothee, director general of the ministry of health, said “patient zero” had yet to be identified. Eight deaths have been recorded in the Artibonite since Thursday.
As the media drifted away, Michel Thieren, head of the Pan American Health Organization in Haiti, offered the simplest assessment. “This is an epidemic that will settle over months,” he said gently.
What is clear is that cholera is now an endemic part of Lovely’s Haiti. And that the Artibonite River has proved a welcoming host.
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By Aton Edwards, Executive Director I.P.N.
Lifestraw NOW! 1,000,000 Water Filters For Haiti Drive Begins!
Five days ago, we were in the beginning stages of assembling the Lifestraw NOW! coalition and team. We’re now in full effect and growing exponentially. Our mission is clearly defined, and we are in the final stages of setting up a financial mechanism that we will utilize to purchase, ship and distribute the Lifestraws across Port-au-Prince & other locations across Haiti.
The situation on the ground is grave. To date, cholera has killed over 1100, and, nearly 30,000 have contracted the disease. The rapidly mounting death toll has created tensions that occasionally explode into sporadic attacks against UN peacekeepers.
Many Haitians believe the UN is responsible for bringing the disease to the Island and, not without good reason. Cholera is not endemic to Haiti and the specific strain that is spreading across the island like wildfire originates in Nepal according to UN health officials, and the Center For Disease Control (CDC) in the USA.
Several years ago in Nepal, a cholera outbreak swept through the nation. During this period, it is suspected that a number of the Nepalese peacekeepers in Haiti contracted the disease.
Our goal - 1,000,000 Life Straws on the ground by February. ~Aton Edwards
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Slumped in a wheelchair in the hospital yard, Dieuson Dorvil had just begun spelling his name when a spasm gripped his chest and he turned away to vomit.
His mother, Isma, held him as he shuddered and heaved, filling a bucket at his feet. It seemed impossible that such an emaciated figure could produce so much but the disease was sucking the fluid from his body.
Around the yard and inside the wards babies and children, men and women, lay curled and motionless, their stares glassy. The only sound was the occasional retch.
Every so often a stretcher with a figure half shrouded in a white, soiled sheet was wheeled to the morgue. They bounced over the gravel and potholes, giving the impression the corpses were trembling.
This is what Haiti's cholera epidemic looks like. It turns people into vomit- and faeces-producing spectres. It is filthy, smelly and a horrible way to die.
The official death toll has approached 800, with 11,000 taken to hospital, and there is dread that this is just the beginning. What started a month ago as isolated diarrhoea cases in the rural Artibonite valley has turned into a nationwide cholera outbreak, with more than 1,000 new cases daily.
People in towns and villages around Gonaïves, in the north, are burying victims in mass graves, according to aid workers and photographers, and suspected cases have been detected in the south and in the Dominican Republic, which shares this Caribbean island with Haiti.
The biggest concern is the capital, Port-au-Prince. Still in ruins from January's earthquake, it is a metropolis of rubble and tents and open sewers that condemn most of its 3 million inhabitants to unsanitary, crowded conditions.
"All of the hospitals in Port-au-Prince are overflowing with patients and we're seeing seven times the total amount of cases we had three days ago," said Stefano Zannini, Médecins sans Frontières' head of mission in Haiti. "I can easily see this situation deteriorating to the point where patients are lying in the street, waiting for treatment."
Outside the gate of the cholera clinic at the city's main hospital lay a teenage girl in a peach T-shirt and khaki shorts. She appeared unconscious, her head lolling at an awkward angle, brown stains down her left leg. No one knew her name or how she had come to be there.
The clinic, an improvised centre with tarpaulin, was full. Before entering, visitors wiped their feet on a ratty yellow cloth sprayed with chlorine. The yard had about 10 silent patients attached to IV drips. The only light was a sliver of moon.
"The doctor hasn't see him yet, I don't know what's going to happen," said Isma, 42, after another bout of vomiting from Dieuson. Eyes sunken, the 24-year-old student drifted in and out of the interview. "It feels like there's something inside, squeezing," he said.
Isma said she was a restaurant cook but that business had evaporated. "No customers. Everyone's afraid of getting the infection." The family lived near the Cité Soleil slum where hundreds, possibly thousands, have been stricken. "My son is the first in our family to get sick," she said, feeling his forehead. "We don't know how it happened."
The clinic's wheelchairs have white plastic seats cut from garden furniture, lending an incongruous jauntiness to the wretchedness. When a patient missed the bucket, or became lathered in slickness, a man with a white mask and blue overalls sprayed chlorine.
In the wards men and women lay on wooden frames with a round hole cut in the middle and a red MSF bucket beneath. "We call it the Calcutta stretcher," said a young Haitian doctor, the only one on duty. "I don't know if we can keep up. It's spreading so fast." From a handful of patients earlier in the week there were now more than 70 daily.
The doctor declined to give his name. With elections due on 28 November, and mounting anger at the government's response to the crisis, the epidemic is politically sensitive.
The UN is also defensive over speculation Nepalese peacekeepers inadvertently introduced the disease, which closely resembles a south Asian variant, into the Arbonite river. Now that it is in the water supply it will last months or years, according to epidemiologists.
The UN appealed today for $163m to respond to the crisis, which it said could infect up to 200,000 people. "Cases are expected to appear in a burst of epidemics that will happen suddenly in different parts of the country," Elisabeth Byrs, of the Office for the Co-ordination of Humanitarian Affairs, told a news briefing in Geneva.
With timely treatment most cholera victims survive, but poverty, fear and a destroyed infrastructure mean many Haitians seek help late, if at all. Records at Port-au-Prince's main clinic showed 24-year-old Marie Renée arrived at Rue Mgr Guilloux at 4.30pm. By 4.33pm she was dead.
A few hours later it was the turn of an elderly man. Evelt Pierre Juste, bearer of the dead, rolled the body, his 16th of the day, up the hill to the morgue. He went fast, lest other patients' eyes lingered on the shrivelled figure. He entered a dank passageway and tipped the body on to a cement floor beside the curled, naked form of Marie Renée. The fridge was locked for the night so the two strangers would lie side by side until morning.
At the morgue entrance a watchman, Wilzor, huddled by a radio listening to upbeat Compas music. He needed to listen to something cheerful, he said. "I ask myself how bad it's going to get. But only Jesus and the disease can answer that."
Rioters and troops clash amid claims from locals that Nepalese soldiers working for UN mission brought disease to country
Rory Carroll in Port-au-Prince guardian.co.uk, Tuesday 16 November 2010 20.25 GMT
They came in 2004 as saviours to a nation which thought things could not get any worse. History and geography had conspired against Haiti, piling misery upon misfortune, but then the blue helmets arrived, and with them hope.
The 12,000 UN peacekeepers, one of the biggest such missions in the world, lived up to their name: they kept peace. Rampaging criminal gangs melted away and anarchy gave way to stability.
But those days seemed a distant memory tonight after clashes between rioters and troops left two dead, dozens injured, foreigners in hiding and an awful question hanging in the tear-gassed air: did the UN mission, known as Minustah, bring cholera to Haiti?
The boys and men hurling rocks and bottles and shooting at foreign soldiers in the northern towns of Cap-Haitien and Hinche had no doubt. Nor did the residents of Port-au-Prince, who greeted UN convoys with sullen stares and insults.
"Minustah merde!" one man on Rue de Silence yelled at a passing pick-up with blue helmets. He made a slicing motion across his throat before being enveloped in a cloud of diesel and dust. Such is the confusion and loathing it was unclear if it was a threat or a comment on the UN's possible role in the cholera outbreak.
The irony that Haiti's putative saviours, in the aftermath of hurricanes and an apocalyptic earthquake, may have brought a water-borne bacterium called Vibrio cholerae has hit what were already fraught preparations for elections on 28 November. Foreign diplomats are holding their breath for the vote to go ahead on schedule.
The facts are thus: an exploding epidemic has killed more than 1,000, infected tens of thousands and spread anxiety through slums and tent cities. There had been no cholera here in living memory. The strain appears to be from south Asia. Soldiers from Nepal, which has cholera, moved into a base beside the Artibonite river in early October. The base has sanitation problems. A week later the river was contaminated and people in the area started vomiting and getting diarrhoea.
That does not add up to proof, and there are alternative explanations, but it seemed good enough yesterday for crowds in Hinche to assault Nepalese troops with bottles and rocks, wounding six. In Cap-Haitien, the country's second city, a police sub-station was torched, roads were blocked and shots were fired at the UN.
"They're targeting [and] fighting with Minustah and so if they see white people, they can rush to judge, and target them too," Jonna Knappenberger, an aid worker in the city, wrote on the Haiti Rewired blog. "Minustah has definitely shot Haitians, at least two are dead, but of course we can't confirm directly. Haitians are firing guns too, we keep hearing it. I personally would fear for my life on the street right now, especially at night."
The UN dispatched Spanish soldiers to Cap-Haitien but today it remained cut off, with burning barricades across roads and metal barriers welded to the bridge leading to the airport.
A UN statement blamed the violence on political agitators and said troops fired in self-defence. "Minustah urges the population to remain vigilant and not to allow itself to be manipulated by the enemies of stability and democracy in the country."
Officials have denied the Nepalese brought cholera and said they all tested negative. Appeals from Haitian leaders and foreign epidemiologists for an official investigation, however, have been ignored.
The controversy has shone a new light on what has been regarded internationally as a successful Brazilian-led mission. Despite extreme poverty and destruction Haiti remains relatively peaceful.
Many Haitians, however, have long criticised the outsiders as a cumbersome occupation force that squanders $500m better spent on building up ramshackle local police and courts.
"Speaking in a personal capacity, I don't know why we have them," said Prospery Raymond, country director of the UK-based NGO Christian Aid. "Yes, we have some gangs but we don't have a war or insurgents."
Most of the population believed the cholera came from the Nepalese and that the UN will do its best to hide it, he said. "If it is confirmed to be from them this will be damaging for the UN and their peacekeeping all over the world."
In comparison US troops, who briefly led relief efforts after January's earthquake, are popular and many people want them back. "Ameriken OK," smiled Michel Ceant, a vegetable vendor in Port-au-Prince. Then he pointed to his mouth and made a retching sound. "Minustah – bleuh!"
Chief Pixelwrangler/Webmaster of Dont4getHaiti.org. With my two friends, Lou and Jim, we are working on bringing ambulances, prostheses and medical supplies to Haiti. Try to help in anyway you can especially 1 year into this as the promised aid funds are still missing and not being used.
