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“They are doing exactly the
wrong thing,” said Dr. Manolo Castro.
“When you bring cholera victims
into a hospital, especially one
with poor conditions, you stand a
good chance of infecting all the patients
in that hospital.”
Dr. Castro, 74, is a Cuban
doctor working at Haiti’s finest pediatric
hospital, St. Damien, in Tabarre.
When it comes to cholera, where a
virulent bacterium provokes severe
vomiting and diarrhea which can
kill in a few hours, he knows what
he is talking about. He has tangled
with the deadly disease before. In 1990, a cholera epidemic
struck the Zambian town where
Dr. Castro was a teacher at a hospital
as part of a Cuban medical mission.
Soon there were some 6,000 cholera
victims. The hospital’s Zambian
director packed up his family and
fled. The Cuban Embassy and Zambian
government asked Dr. Castro to
step in to help the panicked population.
Dr. Castro went to the Public
Health Ministry’s office in town and
with them identified a local stadium
where they could quarantine hundreds
of cholera patients. Within a
few weeks, Dr. Castro’s team of six
Cuban and six Zambian doctors had
brought the outbreak under control. “It is essential to isolate
cholera victims from other patients,
especially where there is poor sanitation,”
said Dr. Castro, who helped
squelch another cholera outbreak
when stationed in the Cape Verde
islands in 1994. “The government
should also stop all traffic and
travel between the affected area
and those not affected. Otherwise,
the disease is going to spread.” The day after Dr. Castro
spoke those prophetic words, it
was announced that Haiti’s cholera
epidemic had propagated from
the Central Plateau and Artibonite
departments (where it emerged) to
Port-au-Prince, the capital through
which thousands of people from all
corners of the country circulate every
day. But far from taking aggressive
and proactive measures
like stopping traffic, Haitian Public
Health authorities have been trying
to minimize the crisis, claiming,
as the Health Ministry’s general director
Gabriel Thimoté did Oct. 25,
that the disease’s progress has been
“stabilized.”
At press time on Oct. 26,
the only official government figures
are that 3,769 people have become
sick with the disease in the Artibonite
and Central departments, with
273 fatalities in the Artibonite. Since
other areas are not being tallied, the
actual figures are much higher. For instance, Dr. Ernst
Robert Jasmin, the Health Ministry’s
Northern Department director, says
that there are 17 probable cases in
Pilate, Plaisance and Limbé, with
three fatalities. Other authorities
report seven cases in the southern
town of Petit Goâve and several other
cases in the town of Arcahaie. But there is also growing
dissension between authorities. Nigel
Fisher, the Canadian assistant
head of the UN Stabilization Mission
in Haiti (MINUSTAH), on Oct. 25
put the death count at 284 and said
that there were five confirmed cases
of cholera in the capital (as did the
Pan American Health Organization
or PAHO). The Haitian government
disputes this, saying only one of the
five cases tested positive. “It is an extremely serious
situation and on the basis of the
experience we have had with other
epidemics in the world, it would be
irresponsible not to plan for a much
larger epidemic,” Fisher said. Ironically,
he dismissed the idea of cutting
off traffic out of affected areas
as impractical.
Dominican health authorities
have not been so sanguine.
They closed the 130 mile-long
border with Haiti on Oct. 25 to everybody
except students and Dominican
visa-holders, who have to
wash their hands and be checked
by health workers at border crossings.
On Oct. 25, MINUSTAH troops fired teargas to disperse a crowd of
Haitians trying to cross over from
Ouanaminthe into the northwestern
Dominican town of Dajabon, reports “Dominican Today.” Meanwhile, Haiti’s cholera
“will not go away for several
years,” said Dr. Jon Andrus, PAHO’s
deputy director, at a Washington
press conference on Oct. 25. “We
know that the bacterium is going
to spread very rapidly and... we
will see a rapid upswing on the epidemic
curve of the number of cases
reported in these early weeks and
months.”
“The official numbers almost surely under-represent the true number of cases
largely because, in general, approximately 75% of the cases have
no symptoms, they are asymptomatic, yet they can carry the
bacterium and transmit it to others,” Andrus said. “And
these same asymptomatic cases may carry the bacterium for up to
two weeks and shed that bacterium back into the environment.” The epidemic is really expected
to explode when it reaches
the 1.5 million people living in some
1500 tent cities sprinkled from the
capital to Léogane. Just like the
sprawling slums of Cité Soleil and
Carrefour, the tent camps lack sanitation
and are regularly flooded by
torrential rain storms. Water used for
cooking and washing often contains
sewage, cholera’s principal vector.
Doctors and medicine
have been pouring in from Haiti’s
neighbors. Cuban Ambassador to
Haiti Ricardo García Nápoles has
traveled to Mirebalais, St. Marc and
other towns to help organize the
response of Cuba’s hundreds of incountry
doctors to the crisis. The
South American alliance UNASUR is
dispatching a planeload of medicine
and equipment to fight the epidemic
on Oct. 27, with medical teams to
follow soon. Brazil said it was making
an additional grant of $2 million
for medicine. Despite the incoming aid,
Dr. Castro is very concerned that
Haiti lacks enough doctors to respond
to this nightmare scenario.
“There is a cholera stool sample
kit, which gives immediate reliable
results, but many Haitian doctors
are not trained in how to use it,” he
said. For the past 13 years, Dr. Castro
has worked at different hospitals
in Haiti and taught at the Aristide
Foundation’s medical school until it
was militarily closed and occupied
by U.S. soldiers immediately following
the 2004 coup d’état against
and kidnapping of President Jean-
Bertrand Aristide. When closed, the
school was producing about 125
Haitian doctors per year, twice the
number of the state university.
“If you multiply 125 doctors
per year, and it could have been
more, by the last six years, you will
see that the 2004 coup d’état has
deprived Haiti of close to 800 doctors,”
noted Hilaire Toussaint, who
runs the Aristide Foundation. He is
now looking for funding to reopen
the medical school next year. The last cholera epidemic
in the hemisphere was in Peru in
1991, which had about 500 cases
over the course of two years, with a
fatality rate of less than 1%.
In 2008, “56 countries
reported 190,130 cases [of cholera],
5,143 of them fatal,” Dr. William Pape, Haiti’s leading doctor in
the fight against the HIV virus, told
Le Nouvelliste. “But many cases
were not recorded due to the limitations
of the surveillance systems
and the fear of sanctions limiting
travel and commercial exchange. It
is estimated that the disease’s true figure is about 3-5 million cases
with 100,000-120,000 deaths per
year.”
“It is going to be a long
battle,” Dr. Pape said. “I fear for the
slums of Port-au-Prince.” |
