In Haiti's slums, the fight against cholera is a never-ending battle

Cholera treatment centres in Haiti have treated tens of thousands of patients in the last two months, but the illness continues to wreak havoc in the country's poorest areas, where access to clean water is limited. France24.com takes a closer look.

By Cyril VANIER reporting from Haiti (video)
Gaëlle LE ROUX special correspondent in Haiti (text)

Before the latest outbreak, Haiti had not been struck by cholera in over 100 years.

Now, nearly three months since the epidemic broke out in mid-October, NGO Doctors Without Borders has treated more than 91,000 patients in the country (which has a population of roughly 10 million). Most of the time, those sick with the disease are cured. But not always.

The never-ending fight against cholera in Haiti's slums At crossing points between "clean" and "dirty" zones, everyone must disinfect the soles of their shoes and wash their hands in chlorine solutions, to prevent bacterial contamination. (Photo: Gaëlle Le Roux) ]">

The cholera treatment centre in Tabarre, a neighbourhood in the northwest of capital city Port-au-Prince, admitted approximately 2,500 patients in two and a half months. Today, the centre is calm, with empty waiting rooms and doctors and nurses able to take the time to sit down and talk to one another.

The atmosphere is much changed since November and December, when sick Haitians flocked to the centre for care. “We pretty much filled up the facility, which can accommodate 250 people, but we never sent patients to other centres”, said Thomas Vandamme, a young French doctor who arrived in Haiti in late October.

Calm before the storm

Though the day has been uneventful, the doctor must keep on his toes. “Peaks have always followed calm periods”, he explained.

His colleague, epidemiologist Kate Alberti, agrees that there is still cause for concern. “You only need one case of cholera to create an epidemic”, she said.

In three quarters of patients, those infected have no symptoms but can nevertheless transmit the disease to others. The incubation period is no more than a few days, and the illness can come on suddenly, with certain people dying of dehydration within hours. “You can lose up to a litre of fluid per hour”, the epidemiologist specified.

In general, patients can be back on their feet in three days, after intensive oral rehydration therapy. But some people, like 35-year-old Yolette, who has been hospitalised for the past ten days or so, have not been so lucky. When she got to the centre on New Year’s Eve, she was so severely dehydrated that doctors were obligated to hook her up to an IV.

“I don’t know how I caught this”, she said. “At home, we boil water and put ‘aquatab’ [water purification tablets] in our buckets”. Yolette’s home is a tent set up near the airport. Purified water is regularly delivered by NGOs, but the epidemic found its way into the camp nonetheless.

The camps are, however, not the areas most affected by Haiti’s cholera epidemic. NGOs seem to be everywhere, distributing water purification treatments and tirelessly repeating hygiene guidelines: use toilets, regularly wash hands with chlorinated water – especially after using the toilets – and purify water before drinking it and using it for cooking.

Purification tablets and chlorinated solution

But humanitarian aid organisations are having trouble accessing certain shanty towns. They are often able to distribute vouchers for purifying tablets or supplies of chlorinated solution, but no treated water. In these places, information about hygiene circulates more slowly and there are delays in treatment of sick people.

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In December, several inhabitants of “Mangue Zone”, a specific part of a shanty town known as Cité Soleil, contracted cholera, and some of them died. Sanitary conditions there are such that survival is a daily challenge. Patches of the ground are covered in garbage, and streams of dark waste flow into the sea. Scrawny chickens and pigs splash around in dirty, foul-smelling water. Still, it is a place where several hundred people live, in houses built of sheet metal heated by the scorching sun.

Mangue de Cité Soleil can be seen as a symbol of the failure of the Haitian state; there are no roads, no clean water, and no electricity. Only a truck from Cadipa, the public water distribution organisation, ventures there several times a week. Cadipa fills up reserves of water, and women come to stock up. The water is drinkable upon arrival, but without being treated it doesn’t stay so for long. It only takes one cholera-infected bowl to be dipped into the supply for the water to turn into poison.

Lack of information

In this region of extreme poverty, following hygiene guidelines is no easy task. The tanks in which water is stored are often far from houses, and a bucket that can hold slightly more than four litres costs the equivalent of two cents of a euro. But when water is rare, that price can climb to ten cents. “That’s why regular hand washing has not really become a habit among people here”, explained Déboner Nelson, who works for Doctors Without Borders, as a hygiene counsellor at the cholera treatment centre in Tabarre.

For Nelson, the biggest danger is a scarcity of information. People here are scared of the epidemic, and they are not informed about the risks they run or the way they can catch or avoid catching the disease”, Nelson said. “Sometimes, when someone here starts exhibiting cholera symptoms, he or she ignores them. And without treatment, cholera is often fatal.

The establishment of a Doctors Without Borders centre in Cité Soleil has improved things. Though it is not located in the impoverished “Mangue Zone”, the centre is close enough for sick people and their families to be swiftly treated. Thanks to continued repetition, hygiene advice is starting to take hold, even if it is not being systematically applied.

Small steps taken every day should ultimately stop the spread of the disease. But optimism is not yet the reigning mood. After killing more than 3,400 people in the country, the cholera epidemic shows no signs of fading. According to Kate Alberti, it might continue for another several years.

“We’re not out of the woods yet”, she sighed.