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Posted October 25, 2010                      
Amid Cholera Outbreak in Haiti, Fear and Misery


ST. MARC, Haiti - Here at the epicenter of the cholera epidemic, about 60 miles north of the capital, scores of children and adults are doubled over in a hospital courtyard, stretched out on benches or cots, racked by convulsive stomach disorder or limp with dehydration. They have buckets by their sides and intravenous solutions dripping into their arms.

On Monday, Martila Joseph sat on one of the benches, tears cascading down her face as she held her all-too-still 4-year-old daughter in her arms. "I don't know if my kid will survive," she moaned.

The cholera outbreak, with 259 deaths and more than 3,300 confirmed cases counted as of Monday morning, has so far been contained to the region around the epicenter - the central rural areas around the Artibonite River.

But the capital, Port-au-Prince, is tensely preparing for its arrival in the densely populated slums and tent camps of earthquake survivors. Treatment centers are being established, soap and water purification tablets being distributed and public safety announcements stressing hygiene.

"It travels with the speed of lightning, I've heard, and it can kill a person in four hours," said Jean Michel Maximilien, a camp leader, on Sunday. "So of course we are all on edge."

The Haitian government reported optimistically on Monday that the epidemic might be leveling off.

"The situation is beginning to stabilize," Gabriel Thimothee, director-general of the Health Ministry, said at a news conference. "Since yesterday we have registered only six new deaths."

Officials emphasized that no new cases have originated in the capital, according to Associated Press. But health experts cautioned that the danger remained high. Daniel Epstein, a spokesman for the Pan American Health Organization, said Monday that in 75 percent of cholera cases, the carriers are asymptomatic. That would mean that the number of people who have the microbe - and could spread it - may be closer to 12,000.

Since the January earthquake, this devastated country has been bracing for a secondary disaster - a hurricane, an eruption of violence, an outbreak of disease. But nobody anticipated that cholera would make its first appearance in 50 years. It was "the one thing we thought we were relatively safe on," said Imogen Wall, spokeswoman for the United Nations humanitarian coordination office.

The catalyst for the outbreak is still unknown. "That's the who-dunnit, the mystery," Petra Becker, a social worker for Doctors Without Borders, said Sunday after washing her hands with a chlorinated solution at the entrance to a fenced-off treatment area for suspected cholera cases at her organization's field hospital here.

As of Sunday, five cases of cholera had been confirmed in Port-au-Prince, but all were individuals who traveled from the Artibonite valley, according to Dr. Michel Thieren of the Pan American Health Organization. Still, five other patients at the Doctors Without Borders hospital were exhibiting symptoms - intense, precipitous diarrhea and vomiting - and are being isolated, tested and treated for the disease.

In a cordoned area with space for 20 patients, the five lay inside tents on beds with triangular holes cut in the heart of the mattress, and a bucket beneath the hole. There were two adults and three children, a few of them hooked up to intravenous drips. One chubby little girl, Neftali Firmin, 5, lay listlessly beside her very nervous mother.

The mother said they lived in the capital city and had not visited the Artibonite valley. Wringing her hands, she said that her daughter grew violently sick to her stomach without warning. Neftali had been given rehydration fluids, but her mother wanted the hospital to give her medicine.

"When are they going to give her the cure for cholera?" the mother asked visitors.

Cholera is an acute bacterial infection that rapidly and dangerously dehydrates the body. If left untreated, it can kill some victims within hours. But the treatment itself is straightforward. Some patients rally after getting a simple solution of clean water mixed with sugar and salt, like what Neftali received. Others require intravenous hydration, and are administered antibiotics.

In a sign of the anxiety in this city, residents of the tent camp that surrounds the Doctors Without Borders hospital displayed their discomfort on Sunday with the creation of the new clinic in their midst. For several hours, they blocked access by placing rocks and ropes on an entry road.

"We're really concerned," Bernard Alcinor, a camp resident, said. "The disease is marching through the country, and we don't want it here."

But after negotiations, camp leaders relented for now and traffic began flowing again to what is still essentially a treatment center in waiting.

Although all are concerned about the crowded, unhygienic living conditions in the tent and tarp camps sheltering some 1.3 million displaced people, the slums are a potentially bigger problem as they do not have even the portable, cleanable latrines that many camps do.

Haitian authorities and international groups have been working to assure a more ample supply of chlorinated water, to clean and disinfect community latrines and to caution the public about hand washing, proper use of water and "defecation in open air."

Copyright 2010 The New York Times Company. Reprinted from The New York Times, International, of Monday, October 25, 2010., the scholarly journal of democracy and human rights
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