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The world watched in horror in December 2010 as Haiti, the poorest country in the Western Hemisphere, was rocked by a 7.0 earthquake. International aid groups and the United Nations jumped into action to help in search, rescue, recovery, and rebuilding efforts. Unfortunately, one group of UN workers from Nepal inadvertently brought an unwelcome gift: Vibrio cholerae [serogroup O1, strain Ogawa, biotype El Tor, to be precise]. Haiti had been free of cholera for decades, but the run came to an end in Febrauary of 2011. It is now Fall of 2014, and the Haitian cholera epidemic continues on having sickened over 100,000 and killed over 8,300. Why? Infrastructure is a big reason. Cholera is a waterborne illness spread by the fecal-oral route (sidebar: yes, that means exactly what it sounds like it might mean, skeevy as it is to think about!). Improper water treatment, both on the ingestion end and waste end, perpetuates these types of diseases. NPR's health blog gives an interesting description here. In any event, cholera has once again gotten a foothold in Haiti, and it isn't likely to be eradicated from the country (or the island of Hispaniola, for that matter) for the foreseeable future.
There are many reasons I like to discuss cholera (there will certainly be a Cholerology Day upcoming!), but a big one has to do with its transmission, pathogenesis, and tendency to disproportionately kill the impoverished. One reason relates back to water infrastructure. Another major one other relates back to medical infrastructure. Believe it or not, cholera is an incredibly treatable illness. The symptoms of voluminous (seriously-we're talking gallons per day) diarrhea are caused by a toxin made by the bacterial agent V. cholerae. Importantly, the symptoms are NOT from V. cholerae in and of itself. The bacteria bug out of there when the symptoms start! Nope, it's all about the toxin. Since cholera patients typically die of dehydration, the treatment is simple: REhydration! If patients are rehydrated until they clear the toxin, they recover nicely. If, however, you haven't any clean water to drink, a hospital nearby with sterile saline/ringers to give you an IV, or the money to afford either if they were available, you're a bit stuck. So, in short, those with access to a very simple treatment live, and those who don't are more likely to die.
We can do better than that.
Wow. Thank you for reaching out with this information. I had no idea that cholera had affected/killed so many, or that it's a toxin from the bacteria that causes the diarrhea, or that the treatment is simply to properly hydrate!
ReplyDeleteAs someone who lived in the second poorest country in the Western Hemisphere (Guyana), I'm still awestruck when I learn about how exponentially worse things are for Haitians. As detailed in the NPR article you linked to, there are no sewers. None. Latrines are a luxury and have to be emptied by hand. Many people just go to the bathroom in a plastic bag and throw it. Until they get sewers, the Cholera problem seems intractable.
Thanks for raising my awareness Meghan!
Meghan thanks for sharing this. Really great insight on a continuing problem that doesn´t seem to get much attention since the earthquake.
ReplyDeleteLike Nate mentioned, living in the 2nd poorest country in the Western Hemisphere, I am not surprised that the lack of sanitary infrastructure is what perpetuates this epidemic. Many rural communities in Guyana didn´t have latrines or had very few ones causing them to defecate into rivers (their primary source of drinking water) or anywhere with some bush cover. In fact, we worked in a small community of only 100 people and Red Cross installed 5 latrines for the community. However, because they wanted these latrines to be (more?) sanitary they built them pretty far away from the houses. Unfortunately, this had the opposite effect as hoped. Since they were so far away, community members continued to defecate outside their doors and not use the latrines. So they just sat there and were used more like trash cans or bat houses!
While reading the NPR article what really stood out to me is that over $9 million of aid has been given to this country, yet no long-term solution has been implemented. So many of these problems have easy solutions but require long-term program and infrastructure implementation. However, it just seems easier to put a cheap band-aid on it and then act surprised when it doesn’t work. Why only build 5 latrines, why not build compost latrines that don’t require someone to empty it out and doubles as a fertilizer? There are solutions out there, they just aren’t being implemented.
I could keep going on about this and the second issue of proper rehydration, but I´ll save you from it. These health issues are near and dear to my heart and being on the ground really helped me understand the many pros and cons of aid organizations and how they don’t always efficiently help these underdeveloped countries.
Thanks for including me in this Dr. May
Thanks for sharing your experiences, guys! If it's okay, may I post your comments as a separate post? Your insight is so, so important to share!! Also, there should be more people like you two in the world ;-)
ReplyDelete