Rebecca E. Rollins / Partners In Health
(Above: Dr. Thelisma Heber cares for a patient at the Cholera Treatment Center in Mirebalais, Haiti.)
Thank you for your support of Partners In Health, Zanmi Lasante (our sister organization in Haiti), and the thousands of people who you've helped to receive treatment for cholera, as well as education and resources to prevent it. Below please find an excerpt from a piece posted on our website this past summer. While we've made great progress in the places where we work in Haiti, cholera rages on.
Haiti never knew cholera until 2010. That’s when the United Nations flew in a group of peacekeepers from Nepal, whose capital had recently suffered an outbreak of the disease, and set them up in a camp with poor plumbing. Contaminated sewage leaked into a tributary of the longest river in the country, the 200-mile Artibonite. Since the first person was diagnosed in October 2010, there have been more than 739,000 cases of cholera and 8,900 deaths, according to Haiti’s Ministry of Public Health and Population.
So why does cholera continue to plague Haiti, and PIH/ZL sites, five years after the initial outbreak?
“We haven’t gotten rid of the reasons for the transmission of the bacteria, and that’s because there’s such poor water and sanitation,” says Dr. Louise Ivers, PIH’s senior health and policy advisor. Since the outbreak began, “there have been no transformative water and sanitation activities, and so the underlying problem is still there. I think that’s why the number of cases has started to go up again.”
Ivers also says numbers may be higher where PIH/ZL operates because the Centre region is one of the poorest in the country and, therefore, has limited water and sanitation infrastructure. Plus, staff actively record cholera cases, something that is not true everywhere in the country because human resources are lacking. A full count of the disease could be much higher nationwide.
In response to the epidemic, the governments of Haiti and the Dominican Republic proposed a 10-year, $2.2 billion plan to eliminate cholera, including investments in new water and sanitation systems. But that plan, announced in 2012 and supported by an international community of donors, is only 13 percent funded.
Some advocates believe the U.N. should shoulder more of the burden for cholera in Haiti. Brian Concannon and the non-profit he co-founded, the Institute of Justice and Democracy in Haiti (IJDH), has requested the U.N. accept responsibility for the initial outbreak. The IJDH filed a lawsuit against the U.N. in U.S. federal court in 2013, but a judge dismissed the case in January 2015. The organization is now appealing that ruling.
Meanwhile, Partners In Health/Zanmi Lasante (ZL) staff do what they can to halt the most recent spike in cases, as they’ve done with others in the past. They mobilize a network of community health workers to find patients, open rehydration posts in remote locations, educate people about proper hygiene and sanitation, and diligently work to bring reliable water and sanitation systems to the region.
More comprehensive work needs to be done. In a 2010 article published in The Lancet, Ivers and Dr. Paul Farmer, a PIH co-founder and chief strategist, laid out a detailed roadmap to break the cycle of cholera. They wrote that health care professionals have to aggressively find and treat cholera cases and administer vaccines such as Shanchol, which Ivers and her colleagues found reduced the number of cholera cases by 63 percent among those vaccinated in villages north of St. Marc. Water and sanitation systems need to be improved. Public health care systems have to be strengthened. And global health policy must be crafted to give cholera the level of attention it deserves.