Haiti Grapples With Highest Cholera Rate In World

Just one year after the cholera epidemic emerged in Haiti, nearly half a million Haitians have contracted the disease and more than 6,000 have died form it. Michel Martin explores what cholera is, and how Haiti's government is making new efforts to tackle the crisis. She speaks with Miami Herald Caribbean Correspondent Jacqueline Charles and Dr. Louise Ivers, who lives in Haiti and works for Partners in Health.

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MICHEL MARTIN, host: I'm Michel Martin and this is TELL ME MORE from NPR News. Now we want to spend some time talking about Haiti, one of those parts of the world that seems to have seen more than its fair share of suffering and seems to have produced more than its fair share of great art.

Later in the program we will meet a choir with roots in the Haitian diaspora that has become one of Cuba's most acclaimed musical groups. They're now on their first extensive U.S. tour and we will meet them in a few minutes.

But first, back to the suffering. You'll remember that devastating earthquake nearly two years ago. In the past year, nearly half a million Haitians have now gotten cholera and more than 6,000 of them have died from the disease, which emerged in the aftermath of the earthquake.

To this point, the response to the epidemic by the country's leaders has been widely viewed as inadequate, but the new government is making a new effort. Here is Prime Minister Garry Conille, who is also Dr. Conille, a medical doctor.

Prime Minister GARRY CONILLE: We'll take the opportunity of the cholera epidemic, actually, to rebuild our health system and make sure that it's much more effective in providing services to people. I'm very confident that with the support of our key partners, we'll be able to make a significant, significant improvement in that situation.

MARTIN: That was Prime Minister Conille in conversation with Miami Herald reporter Jacqueline Charles. She's been with us many times to talk about Haiti and she joins us once again to talk more about the current situation. Also with us, Dr. Louise Ivers. She lives in Haiti and works with Partners in Health. She helps manage that organization's medical service team in Haiti. And they're both with us now.

Thank you both so much for speaking with us.

JACQUELINE CHARLES: Thank you for having me.

Dr. LOUISE IVERS: Yeah, thank you. Hello.

MARTIN: Dr. Ivers, I'm going to start with you and ask you to remind us again what cholera is and why it is such a problem in Haiti right now.

IVERS: Of course. Cholera is a bacterial infection. It's transmitted through contaminated water supply, and once the bacteria has been introduced into an environment where water and sanitation are lacking, there's a high risk of transmission from person to person and continued illness of many different communities and many different people.

Because the health system in Haiti is so fragile to begin with, long before the earthquake, this was also true. This health system has had a very difficult time initially in responding to the outbreak of cholera and then that's continued because of the lack of good water and sanitation available for people, which would allow them to prevent themselves from becoming infected with cholera.

MARTIN: Jacqueline, do we know - as we reported, as you reported, the cholera has not been known in Haiti for the last two decades and then these reported cases emerged just after the earthquake, and we can understand, you know, how - with the lack of a sanitation infrastructure and a lack of sort of consistent health services - how this could spread, but do we know how it started to begin with? Do we have any sense of the origin of it?

CHARLES: Well, there's been a lot of debate and talk about this, especially as it relates to the United Nations troops from Nepal, and this has been a very controversial issue because the U.N. itself has done a report, and while that report did not directly implicate those individuals, I mean among a lot of people in Haiti, they believe that cholera has arrived there for the first time in a century because of these troops, because of the sanitation near the base where they are, the water supply became contaminated. But the U.N. has not said that in their own findings or their own independent studies, but that is the feeling and that is a very touchy issue in terms of the debate.

MARTIN: And so you would you – you recently spoke with Dr. Conille, the new prime minister, as we said. Could you just tell us a little bit more about his plans to curb this?

CHARLES: Well, he did say that he is, you know, willing to use the vaccination that Partners in Health has recently announced. At the same time, he wants to put out young people as community healthy workers and just send them out to these communities, because today, reaching these remote villages is so incredibly difficult. Some of them are two and a half, five hours, just walking just to get to them, and so the news even of what is cholera - many of them don't know because they've been cut off via communication. They don't have cell phone access and so that remains a great challenge today in Haiti, especially when it rains. That's when we start to see the spike in cholera, so we have to continue to educate Haitians in a public education campaign until we can address the issue of good water and sanitation.

MARTIN: If you're just joining us, you're listening to TELL ME MORE from NPR News. We're talking about Haiti's cholera epidemic and new efforts to combat the disease. My guests are Dr. Louise Ivers of Partners in Health and Jacqueline Charles, Caribbean correspondent for the Miami Herald, who's been reporting on this.

And Jacqueline, could you just remind us again of why this vaccination program has been controversial to this point?

CHARLES: Well, initially the previous government - they were concerned about rolling out a vaccination program when there was such limited supply in the marketplace - 200,000 doses - and we were about to enter into an election. And in Haiti, you know, elections can be chaotic, as we saw with the previous, you know, presidential elections.

So they did not want to, you know, stoke(ph) social unrest, and so, you know, that was their main issue. At the same time...

MARTIN: I'm sorry. I don't understand. Are you saying that the concern was because there were only 200,000 doses then available, there was a question of, like, how would it be distributed and how could it be seen as fair? Was that the issue?

CHARLES: Exactly. And not having people use this in some sort of political means and so there was a lot of questions. How do you decide who gets it? Where do you distribute it? And so that was, you know, their issue and their argument for not going that route.

At the same time, I have to tell you, since this announcement has been made, there remains concern on the ground in Haiti among medical doctors about this vaccination and about whether this is a route that the country needs to take. So there is still some debate that is going on in discussions, despite the fact that the current administration has reversed the previous administration's decision and they have shown a dramatic policy shift in now going the route of the vaccination.

MARTIN: Who will receive the vaccination? Who is targeted for it? Has that been decided?

IVERS: Well, I'll answer that. The 200,000 doses of the vaccine that are available is a very simple issue of supply and demand. The vaccine is produced by a commercial company and as soon as they have a purchase order for larger amounts of the vaccine, they will produce larger amounts of the vaccine.

So if, for example, in October of 2010, when the outbreak began, we had ordered cholera vaccine, there would be several million doses of the vaccine available at this stage, so the issue of availability of the vaccine is a little bit of a red herring. It certainly wouldn't be the first time that a program, a public health program was rolled out as opposed to attempting to vaccinate five or ten million people all in one go.

What we're planning to do as we begin the rollout of the available doses is to cover a geographic area in urban Haiti and a geographic area in rural Haiti. Both areas have very poor access to water and sanitation and will provide us with the opportunity to be able to document the logistics and feasibility issues that have raised some concern amongst those who are wary of trying to use this tool in Haiti.

MARTIN: And Jacqueline, could you clarify for us - as I understand it from both of you, that the root of this is sanitation, is access to potable water, drinkable water, and also clean water for purposes of washing and so forth. And whatever the sanitation infrastructure is, I think many people will remember that there was a tremendous effort by the international community to raise money to support Haiti's rebuilding efforts in the wake of the earthquake. It got tremendous attention around the world, particularly in the U.S., where there's a large Haitian community.

And I think many people might wonder, why were there not sufficient resources to address this problem since it seems to be an obvious one? So can you just help us understand this?

CHARLES: Well, I have to tell you, when cholera first broke out, I went to an area called Grande Saline. It's an inlet where they had the highest cases, because this is where the Artibonite River, which was contaminated, went out to sea. And there were 30,000 people who supposedly lived in that community and supposedly only 50 latrines. I still have not seen the first latrine.

The people were washing and using the river, you know, as their drinking water. They were using the sea as their bathroom, and so when you talk about an earthquake, a lot of the focus was in the urban areas that were struck by the quake, but when you talk about a country where very few people have access to portable water and to sanitation, you clearly cannot expect that this issue is going to get solved in a matter of 12 months or even 24 months. I mean, this is really an issue about access to water and sanitation, which should be rights, but unfortunately in Haiti, they are luxuries.

MARTIN: And Dr. Ivers, if I could have a final thought from you.

IVERS: Long term investment in public water and sanitation facilities is absolutely critical, not just for cholera, but also for the many other diarrheal diseases that result in a lot of children in Haiti under five dying every year. That's really the most important thing.

And in the short term, continued support in treating cholera cases, support of this vaccination campaign, as well as investment in the public health system should help in many ways for Haitians to have better health.

MARTIN: Dr. Louise Ivers works for Partners in Health in Haiti. We caught up with her in - actually in Ireland, where she's traveling at the moment. Jacqueline Charles is the award-winning Caribbean correspondent for the Miami Herald. She was kind enough to join us from member station WLRN in Miami.

Thank you both so much for speaking with us.

IVERS: Thank you very much.

CHARLES: Thank you.

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