Reflecting on the Cholera Outbreak in Haiti, Three Years Later

Dr. Charles Patrick Almazor, from Port-au-Prince, Haiti, is director of clinical services for Zanmi Lasante, Partners In Health's sister organization in Haiti. He has worked for PIH and ZL since 2001, and was one of the doctors who saw the first cholera patients in St. Marc. He wrote the following reflection about the disease, which had never been reported in Haiti before the Oct. 19, 2010, outbreak three years ago.

Haiti is known for its torrential rains. Sometimes they begin slowly and build to a crescendo, and other times they fall suddenly and loudly and wildly. The sound of the Caribbean rain hitting your rooftop can be enjoyable and soothing if you are in a safe place—warm in your bed or lying on your sofa. The very same rains can be a nightmare for those living in flooded areas or tents. For me, the rains bring back a flood of unpleasant memories.

These memories include the hundreds of patients I saw during a past rainy season in cholera treatment centers (CTCs) in the Artibonite region of Haiti. The patients—the lucky ones who were taken to a clinic—were transported by family and community members on traditional stretchers, a straw mat on an iron bed supported by two thick sticks and carried by four men. Our patients’ eyes were sunken into their skulls, their skin as parched as the dry season. Because of their appearance, they were referred to as zombi lage, fleeing zombies. Patients of all ages laid on their cots, throwing up what they hardly found to eat, since for most of them food is a scarce resource.

I still remember a young man who was the head of his household. He was terrified of dying because he did not want to leave his family behind in dire poverty. I asked him where he lived. His wife was quick to tell me they lived in the Chaos Mountains, dramatically named for the steepness of the mountain chain. It took them six hours to walk to the hospital. Even more tragic, the patient told me he knew about the risk of cholera, but the family ran out of chlorine to treat their drinking water. His wife added that the market was closed because of the continuous rains.

When I left the CTC, the patient had already received eight liters of intravenous fluids to treat the deadly dehydration that accompanies cholera. His face had changed completely. He once again looked like a normal, living human being. I went away with the confidence he would make it.

Cholera is a good illustration of the vicious cycle of poverty and disease, in which the most vulnerable people are most likely to be victims.

I’m a doctor and I have been working in Haiti for more than 10 years. This was my first exposure to such a severe diarrheal disease capable of killing so many people so quickly. On October 20, 2010, I cared for some of the first patients who came to St. Nicolas Hospital in St. Marc, Haiti, the epicenter of the cholera outbreak. It was painful to see so many patients and too few nurses and doctors.

I worked all night at the hospital with a few colleagues; we were two doctors and six nurses for more than 300 patients who needed IV fluids. We were overwhelmed by the immensity of this tragedy. Many of those 300 patients died that day. They came too late to the hospital and from too far away to be taken care of by too few providers.

Cholera is a good illustration of the vicious cycle of poverty and disease, in which the most vulnerable people are most likely to be victims. It is a water-borne disease. Haiti has been struggling to provide clean water to its citizens since its independence in 1804. Will it be feasible to do so in the next decade?

Cholera is spread through bacteria in fecal matter that contaminates water that people ingest; poor sanitation creates conditions ripe for transmission. How much time will it take before we can provide basic sanitation to the 83 percent of Haitians without latrines? It’s these questions and the lack of answers that frighten me—not the rains.

Cholera killed 5,000 Haitians in its first year. Today, three years after the outbreak, about 8,400 Haitians have died from cholera and more than 685,000 have become sick—approximately one in 15 people. The outbreak was quickly classified as the worst cholera epidemic in the world. In one year, a germ we never had was introduced into our country, followed by a disease we’d never seen. How can we protect our patients and their families from this disease? How can we protect the thousands more who live far from any health facility?

These days, it’s been raining heavily. If you are reading this, you are probably safe, warm, and dry. In Haiti, these rains put people at risk. In an ideal world, we would have a comprehensive approach for fighting cholera—preventing transmission with clean water sources, hygiene education, and latrine construction.

Unfortunately, it will take many years before most Haitians have access to potable water and latrines. I don’t know how many years it will take. But what I do know is that there are scientifically proven measures to prevent and treat cholera—including oral vaccine—that can stay the worst of the illness while long-term water and sanitation improvements are made.

My hope for the very near future is that we bring all these tools to bear on an epidemic that has caused needless suffering and death for the last three years.