Just as in Gabriel Garcia Marquez’s novel Love in the Time of Cholera, the cholera patients we see at the hospital are among the poorest in this region; landless day laborers, renters, people who draw water from polluted sources, and those with no latrines. As long as these populations continue to suffer from at best, rudimentary resources for personal hygiene, they will continue to be the source of future cases of cholera.
During my daily rounds in the hospital, I recently encountered a young mother with her child as they left the Pediatrics Cholera Treatment Center. After 4 days at HAS, they were returning to their village in Labady, on the other side of the Artibonite Valley, which reminded me that after almost 4 months since the beginning of the cholera epidemic in the Lower Artibonite Valley, the number of new cholera cases we’ve received each day has begun to stabilize.
International agencies such as Medecins Sans Frontieres, which had supported CTC’s in this region, have closed and moved to other parts of Haiti where the cholera epidemic is in its earlier stages. Some of our new cholera patients come from areas which had been served by these recently relocated units.
Based on experience with cholera in other countries, we expect to receive new cases of the disease, but the incidence will vary over time. It’s also safe to assume that we’ll be seeing an increase of admissions during the summer’s rainy season, with other environmental issues contributing to new cases as well.
We’ve learned to be efficient in providing care for patients with cholera; we’ve also developed effective educational tools, such that most residents of our region know how to treat water and wash their hands, and to prepare food in a safe way. Our major challenge will come from those who know how to prevent the disease, but who lack the resources to implement the ability to do so.
Now, we find ourselves shifting gears, and refocusing on the root causes of the spread of cholera in our district; among our highest priorities will be to build as many latrines as possible in the high-risk areas, and to continue to provide greater access to pure water. This is a long-term strategy, born of necessity. We have done this before, but never at the scale which we now envision. It will be a continuing race against the organism which causes the disease and to try to break the cycle of infection.
Cholera now joins tuberculosis, malnutrition, and other refractory diseases in Haiti which are resistant to preventive intervention. Both preventing and treating cholera will continue to be a major commitment for HAS, and will require much of our energies for the foreseeable future.