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A SPECIAL SECTION:  Haiti, Since the January 12, 2010 Earthquake
Posted November 8, 2010
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Hurricane Gives Cholera New Life in Haiti


ST. DENIS, Haiti - Three medical workers arrived at a clinic near here over the weekend on a mission to deliver supplies and spread the word about preventing a deadly cholera outbreak from getting worse after the torrential rains brought by Hurricane Tomas.

What they found was a locked gate, a sick 3-year-old boy stricken with unrelenting diarrhea being cradled in his father's arms and a gathering crowd of others waiting to get in.

Several of them said, yes, they drink water from a river known to be contaminated with the cholera-causing bacteria. And, no, they don't always have money to buy bottled water.

"We know there may be cholera in there, but sometimes it is all we have to drink," said Alienne Cilencrieux, 24. "If we have Clorox, we pour some in and drink it. It tastes bad. Or we dig in the ground until we find water and drink that."

The cholera outbreak, which has killed more than 500 people and sickened more than 7,000 in the past two and a half weeks, is largely confined to this region of rice paddies and small settlements, where the water has long provided life and livelihood.

But after Hurricane Tomas dumped several inches of rain as it passed on Friday, health authorities are racing to keep people from drinking unsanitary water, particularly here, where the Artibonite River is known to be contaminated with the disease.

At the public hospital in nearby Petite Riviere, the number of cholera cases has grown since Friday, after trailing off during the week. But doctors said it was too soon to say whether it was an anomaly or a worrisome sign that what is already an epidemic may worsen with the flooding.

There were also several reports of suspected new cases in far-flung areas of the country, including several cases under investigation Monday in the capital, Port-au-Prince, raising concern that the disease may have spread there.

The city's overcrowded earthquake survivor camps and unsanitary conditions could promote the disease. But previously, the only cases confirmed in the capital were among people who had traveled from already affected areas.

Surges in suspected cases are common, as people confuse common diarrhea with cholera, which is much worse and can quickly dehydrate and kill its victims if untreated.

Even spikes in confirmed cases have "happened from time to time, and it may not be directly related to Hurricane Tomas," said Crystal Wells, a spokeswoman for the International Medical Corps, a group working here in the Artibonite River region. It is now building a cholera clinic at a hospital in Gonaives to handle the surge of suspected cases there.

Singer Ronald, a spokesman for the Health Ministry, said Monday it was testing the new cases to confirm the disease and determine where it may be spreading.

In the countryside, medical workers from Doctors Without Borders have quickly found that they had to battle not only the water, which is everywhere, but also the fact that generations of Haitians use the river and its tributaries for almost everything.

Rice farming requires heavy water use, and irrigation ditches and branches from the Artibonite lace through here. The people cook with it, and wash clothes in it. And most alarmingly for those trying to check the spread of cholera, which is found in feces and spread through water, the people sometimes defecate in it.

"The two things we do not have enough here are bottled water and latrines," said Ruben Petit, a local pastor helping the workers educate the community.

Anne Khoudiacoff, a Doctors Without Borders physician, said it was impractical to tell people not to wash or bathe in the waters, even with the risk of incidental consumption, because of the lack of alternatives.

Instead, the focus is on urging people not to consume it directly and delivering purification tablets and bottled water far and wide.

Still, many residents said they often cannot afford to buy the tablets or bottled water. They depend on distribution from aid groups, several of which fanned out over the weekend to deliver supplies.

"We worry about it a lot," said Solomon Pierre, who lives in a farming hamlet near L'Estere in this region, adding that one of his seven children had cholera but recovered. "Before the cholera we drank from the river and the canals all the time. Now we try not to."

Away from population centers, rural victims often get sick, try home remedies and travel long distances to crowded public hospitals, arriving in advanced, acute stages of the disease with an increased risk of death.

In St.-Marc on Saturday, cousins of Alexandre Sylvestre, 33, struggled to carry him as he drifted in and out of consciousness, soaked in vomit and diarrhea. They had driven nearly an hour by motorcycle. "We thought he was going to die," said a cousin, Jacques Altidor, his own clothes now sopping.

To try to improve local treatment, Doctors Without Borders and other aid organizations have been building clinics in rural areas where they can stabilize and treat victims, distribute water and purifications kits and teach people practices to avoid contamination.

It does not always go smoothly, as a Haitian nurse and two medical workers who arrived last week from Belgium discovered on Sunday.

The gate to the clinic where they had earlier prepared a tent for cholera treatment was locked because of a misunderstanding with Health Ministry officials, who thought the group planned to open Monday, not Sunday.

Nobody with a key could be found.

Eventually an ambulance was summoned, and the sick 3-year-old boy, Feguerson Saint-Elien , and five other suspected cholera sufferers piled in for the half-hour trip to a hospital here, where they were undergoing treatment.

Later, the workers went to a local radio station to urge them to broadcast a cholera awareness message. The station manager said he would be glad to, for about $125. He needed gas, he explained, to run the station's generators. (He accepted about $50.)

The need for information is clear.

Pastor Petit said many people confuse ordinary diarrhea, very common here, with cholera. But health workers do have signs that cholera awareness is spreading. At the Hospital Charles Colignon here, the bodies of three cholera victims have sat for nearly three days on the ground in a closed-off area, sprayed down with chlorine and zipped in white plastic bags that, funeral directors are told, must not be opened, not even for burial.

Relatives are too fearful of the disease to claim the dead.

Vladimir Laguerre contributed reporting.

Copyright 2010 The New York Times Company. Reprinted from The New York Times, International (online version), of Monday, November 8, 2010.
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