The best of intentions: Cholera in Haiti

The earthquake which struck Haiti in 2010 resonated world wide.  Concerned humans gave money, donated time and exuded compassion.  Despite these best of intentions, the way that people helped was often symbolic.  A few charities got rich on the quick cell-phone donations.  More than a few donations went astray, and of course, some of the people helping brought carnage.

Like the Nepalese workers contracted by the United Nations who brought cholera with them.   In December, an Al Jazeera camera crew filmed UN workers dismantling latrines which dumped right into the Artibonite river.   Shortly thereafter, a respected epidemiologist announced that Cholera was most likely brought by the UN.  The Nepalese denied this.

Epidemiologist Renaud Piarroux conducted research in Haiti on behalf of the French and Haitian governments.

Sources who saw the report said it had evidence the outbreak was caused by river contamination by Nepalese troops.

The UN said it had neither accepted nor dismissed the findings. The Nepalese army condemned the study as unfounded.

The cholera epidemic has killed 2120 people, and nearly 100,000 cases have been treated, according to the Haitian government.

via BBC News – Haiti cholera: UN peacekeepers to blame, report says.

While people debated the cause, Haitians died.  How bad was it?  In the spring, citizens enraged by rising deaths began piling up coffins of dead relatives in the street to protest lack of action.  You’ve got to be pretty angry (and out of options) to put your dead family members out  as protest blockades.

photo from the SF Bay Guardian, taken by Ansel Herz

What was the response to the Haitian indignation?  Mostly the United Nations denied their responsibility, leaving Haitians dying of Cholera.  This morning, Spoonful of medicine brought the fascinating news that the UN had looked into the subject and yes, in fact, it looks like the UN brought the deadly disease, although they share the responsibility for the spread of the disease with the earthquake itself.

Here is a quote from the actual UN report, written in classic bureaucratic language, but clear enough for my purposes:

“Based on the epidemiological information available, the cholera epidemic began in the upstream region of the Artibonite River served by the Mirabalais Hospital on October 17th, 2010. This region has little to no consumption of fish or shellfish products, which are known to be associated with outbreaks of cholera worldwide. Therefore, the most likely cause of the outbreak was the consumption of contaminated water from the river. An explosive cholera outbreak began on October 20th, 2010 in the Artibonite River Delta, indicating that cholera had spread throughout the Artibonite River Delta within two to three days of the first cases being seen in the upstream region.” UN-cholera-report-final.pdf (application/pdf Object).

The United Nations volunteers contracted for a trucking company to remove their waste.  Here is the waste removal strategy, sometimes called out of sight/out of mind:

The contracting company dispatches a truck from Port-au-Prince to collect the waste using a pump. The waste is then transported across the street and up a residential dirt road to a location at the top of the hill, where it is deposited in an open septic pit (Figure 11). Black water waste for the two other MINUSTAH facilities – Hinche and Terre Rouge – is also trucked to and deposited in this pit. There is no fence around the site, and children were observed playing and animals roaming in the area around the pit. UN-cholera-report-final.pdf (application/pdf Object)

How do you know that this is caused by the UN workers?  Well the strain of Cholera is identical to the strain in Southeast Asia.

A careful analysis of the MLVA results and the ctxB gene indicated that the strains isolated in Haiti and Nepal during 2009 were a perfect match. The strains isolated in Haiti are also perfect matches by MLVA and ctxB gene mutations with South Asian strains isolated between or since the late 1990’s.  UN-cholera-report-final.pdf (application/pdf Object).

And of course lets discuss the cover-your-ass conclusion paragraph.  After thirty pages of exposition explaining the 99% likelihood that the UN disaster assistance brought more terrifying disaster to Haiti, the report authors punk out.

The introduction of this cholera strain as a result of environmental contamination with feces could not have been the source of such an outbreak without simultaneous water and sanitation and health care system deficiencies. These deficiencies, coupled with conducive environmental and epidemiological conditions, allowed the spread of the Vibrio cholerae organism in the environment, from which a large number of people became infected. The Independent Panel concludes that the Haiti cholera outbreak was caused by the confluence of circumstances as described above, and was not the fault of, or deliberate action of, a group or individual.

The source of cholera in Haiti is no longer relevant to controlling the outbreak. What are needed at this time are measures to prevent the disease from becoming endemic.

The claim that the “deficiencies” of the Haitian health care system are equally responsible for the introduction of the disease into Haiti is ridiculous.  These factors account for the spread of the disease, but certainly not the introduction.   No longer relevant?  How about for the next United Nations disaster relief?  How about for the kids dying of cholera in Haiti this morning?  Seems like victim blaming to me.

Responding to a natural disaster provides the kind of cover for half-assed assistance.  Because of the “disaster” the lack of reflection can be blamed on the need for speedy action.  The risk of this is that we excuse terrible decisions, because the people were ‘trying to help.”

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Filed under disaster, health, human rights, propaganda

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