The map to the left reflects the data which is published each week from the Haiti Ministry of Public Health and Population, as reported last week. It clearly shows the concentration of cases, during the first month of the epidemic, in the lower Artibonite River valley, and the central role which HAS has played in managing the first phase of this epidemic. HAS has worked in collaboration with MSPP institutions in St. Marc and Petite Riviere, which are directly supported by Partners in Health and Medecins Sans Frontieres; each of these institutions have received more cholera patients than HAS, and HAS has been able to support them by providing diagnostic and surgical services to non-cholera patients.
As the disease continues to extend its reach throughout the rest of the country, these circles will appear and grow in other population centers as well, including Port au Prince. However, it is unlikely that we will see any significant diminution of new cases of cholera during that time at HAS.
The cholera epidemic appears to have gone through several phases, in which the first phase included young men, working as migrant laborers in the rice fields in the Artibonite delta, who were drinking water from the river and canals. The second phase was characterized by patients whose wells may have been infected by rising waters from rivers and canals following the hurricane Tomas. Also at the same time, the third phase was starting, in which the disease is transmitted by human contact from people who are asymptomatic carriers of the disease.
It is this pattern which now dominates the new cases in our area, especially among the relatively poorer residents who do not have access to clean water to drink, or to sustain appropriate hygiene, even for the most basic preventive techniques of hand-washing.
Many of us are about to enjoy a Thanksgiving with family and delicious foods. Perhaps it would be appropriate to pause occasionally during the day and give thanks for the municipal water system which brings potable water to our sinks, and for the miracle of a flush toilet, which carries away waste and processes it to preserve the health of the community. And to reflect on our Haitian neighbors who in the absence of these gifts, struggle with great dignity and creativity to establish some semblance of a healthy life.