With the eyes of the world’s worried turned towards Africa’s Ebola crisis, many have not noticed that since 2010, cholera has infected over 730,000 people and killed over 9,000 Haitians.
Never declared an official state of emergency, the cholera pandemic in this island country has gone unnoticed by entire sectors.
The virus came to the country through the United Nations, when volunteers from Nepal practiced unsafe sewage disposal at a base in a rural area of the country. Groups and activists are currently fighting to have the United States take responsibility for bringing the pandemic into Haiti.
The outbreak began in September of 2010, ten months after the devastating earthquake in January of that year.
Nongovernmental organizations, such as Doctors Without Borders, and the United Nations worked toward stemming the spread, and aid poured in. Tolls were worst from 2010 to 2012, but after that, death tolls were being cut almost in half annually. With the launch of 2013’s “10 Year Plan for the Elimination of Cholera in Haiti,” and 2014’s Total Sanitation Campaign, eradication of the disease seemed within reach.
However, in the first quarter of 2015, the number of cholera cases in the country tripled in comparison to the first quarter of 2014. The resurgence seems to have started in the slum of Martissant in September of 2014. Exhausted medical volunteers, who have not been paid in months, work tirelessly in Cholera Treatment Centers (CTCs), administering an oral rehydration solution and IV drips as patients lay in “cholera cots,” which have holes in the bottom with a bucket underneath to accommodate the severe diarrhea experienced by cholera patients.
Efforts to fight the disease have been largely prevention-based, with an emphasis on sanitation through use of various levels of disinfectant and the provision of chlorine to the population. However, to many Haitians, public outreach efforts seem not only redundant, but unhelpful. Not surprisingly, being told to “wash your hands” and “keep yourself clean” by glossy pamphlets and foreign officials while your family members are dying does not offer much comfort. Citizens know what to do, but cholera still lingers.
At this point, a shift is being made towards the use of vaccinations, as one called Shanchol in particular gains favor for repeatedly demonstrating its effectiveness. For example:
- In 2012, it was used to fight a cholera outbreak in Guinea, and was found to provide 86% of the population protection early on.
- According to a current study conducted in Dhaka, Bangladesh, it provided 58% protection to individuals who received it along with soap, chlorine and hand washing instructions (and 53% when administered independently.)
- In its Calcutta trial, whose results were published in 2011, it was shown to give 65% protection.
When compared to other forms of cholera vaccination, it is impressive because it is supposed to last at least five years; it is two-dose regimen costs only $3.70 (and the Bill & Melinda Gates foundation is working to bring prices down even lower); it is ingested orally rather than injected; and it is able to enter the gut and prevent transmission.
The battle against the disease is ongoing, as is the legal fight between several Haitian organizations and individuals and U.N. representatives to hold the United Nations accountable for bringing “U.N. Cholera” to the country.
However, even with what some are calling the “fight for justice,” and the relative lack of awareness of the pandemic in light of the African Ebola crisis, there is hope for the cholera victims of Haiti in more ways than one.
With the rise of the Shanchol vaccine, a resurgence of cases that brought with it a resurgence of awareness, an impassioned population and the tireless volunteers or long-unpaid workers working to combat the disease, cholera is facing some formidable foes.
– Em Dieckman