Improved Coordination, Wider Access to Treatment Could Help Stop Cholera’s Spread in Haiti

Dec. 7, 2010Bookmark and Share
Ten months after a devastating earthquake killed thousands of people in Haiti, a new challenge has already taken the lives of more than 2,000. A cholera epidemic that began in the Artibonite region, located roughly 50 miles north of Port-au-Prince, has spread to the slums of the capital city. It has killed people in all but one of the country’s provinces and is still spreading.
Officials in Port-au-Prince, Haiti, fear that the cholera epidemic could spread to temporary tent communities like the one shown here.
Officials in Port-au-Prince, Haiti, fear that the cholera epidemic could spread to temporary tent communities like the one shown here.
“It could get a lot worse; it depends on how well we act now. All we can be sure of is that it will not disappear as quickly as it appeared,” said Richard Garfield, the Henrik H. Bendixen Professor of Clinical International Nursing at Columbia’s School of Nursing and clinical professor at the Mailman School of Public Health. Garfield has been working on projects in Haiti for the past 30 years. Since January, he has assisted the U.S. Centers for Disease Control and Prevention, the United Nations and the Haitian government to organize relief and recovery programs on the ground. He has also helped support the National School of Nursing after it was destroyed by the earthquake.
Cholera is a bacterial infection that is often fatal. Humans become sick after being exposed to water contaminated with fecal matter. Many people can be infected without experiencing any symptoms; however, they can still pass the infection on to others. A cholera infection causes extreme vomiting and diarrhea, and can quickly lead to severe dehydration and death. According to Garfield, the window between initial infection and death can be very small.
“There are three factors that cause cholera among humans: waste going into surface water, people drinking from surface water and having no immunity to cholera,” said Garfield, who specializes in health services delivery in humanitarian crises. “Once someone shows symptoms, if left untreated, that person could die in a day.”

On Dec. 6, Haiti ’s Health Ministry reported that more than 90,000 cases have been logged since the outbreak began in October. Experts warn that the toll will likely climb higher before the epidemic is brought under control.
In Port-au-Prince, cholera has remained largely in the city’s slums, including Cité Soleil, where few people have access to clean drinking water. Because communities located in temporary tents are being serviced with potable water by nongovernmental organizations, most have so far remained unaffected. However, crowded tents, weak health and sanitation infrastructure worry officials who fear that the epidemic could ravage the rest of the city. Preventive measures, like clean-out of polluted waterways and latrines, have begun in order to reduce transmission risk.

“A lot is being done, but not enough. With so many organizations on the ground, coordination is a big challenge, and with government overstretched, the coordination is even weaker,” said Garfield, who believes that improved coordination and widespread access to treatment could hold off a catastrophe.
“Cholera is very treatable, and it is very cheap to do so. People must be treated quickly to prevent additional fatalities.”