How We Helped PaveHaiti's Road to Cholera Hell.Canada and the UN have committed public health malpractice on a very large scale.By Crawford Kilian (The Tyee). Dady Chery (Axis of Logic)Sunday, Jul 24, 2011Editor's Note: Below the following Crawford Killian analysis, see articles by Haitian Dady Chery, Axis of Logic Columnist in which she identified the source of the cholera epidemic in Haiti on October 22, 2010, just 4 days after the presence of cholera was confirmed by the Cubans and weeks before the corporate media admitted that the source was a UN camp on the Arbonite River. Chery laid responsibility for the epidemic squarely at the feet of MINUSTAH and the UN.
- Les Blough, Editor
On Oct. 18, 2010, Cuban medical personnel in rural Haiti reported they had treated 61 cases of acute watery diarrhea in the previous week. On that same day they had another 28 cases and two deaths.
That was the start of a public health catastrophe that has so far infected over 370,000 Haitians with cholera and killed over 5,500 of them. A proportionate epidemic in Canada would have sickened 1.2 million of us, and killed over 18,000.
It was a totally avoidable epidemic; worse yet, it was brought to Haiti by the UN peacekeepers who were supposed to be protecting the Haitians. Since Canada is involved with MINUSTAH, the UN agency that effectively runs Haiti, we share some of the responsibility for inflicting needless suffering on an already traumatized country.
First cholera in Haiti in 100 years
Ever since 2004, when the U.S. and Canada encouraged the ouster of President Jean-Bertrand Aristide, the nominal government of Haiti has been ineffective, especially the Ministry of Public Health and Population (MSPP). Haiti has been run by MINUSTAH and thousands of non-governmental organizations. They range from the Pan American Health Organization (PAHO) and Medecins Sans Frontieres to religious groups.
When cholera arrived last October, Haiti had not seen it in a century, if ever. It had started along the Meille River in a rural area, downstream from a MINUSTAH peacekeepers' camp that had just received a contingent of Nepali soldiers, and suspicion fell on them at once.
After all, they had left Nepal in late September during a cholera outbreak. While they had all had medical exams (including stool tests), they had then been granted ten days' home leave before reassembling in Kathmandu.
Deny, deny, deny
The Nepalese army denied that its troops were to blame. MINUSTAH also denied the accusations, claiming the Nepalis had tested negative for cholera.
Under pressure, the UN finally arranged for an investigation into the origin of the outbreak. That report was published on May 4, after cholera had been raging for over six months. Indirectly it admitted the Nepalis had brought the disease, but it didn't mention them explicitly; it spent more time blaming the Haitians for their lack of clean water and a sewage system.
Meanwhile, a team led by Renaud Piarroux of the Université de la Méditerranée had done its own survey in November 2010. It found the Nepalis the likely source, but needed more evidence. After further work, Piarroux has just published a more detailed report in Emerging Infectious Diseases, a journal of the US Centers for Disease Control.
Appearing in a peer-reviewed journal with the implicit support of the CDC, Piarroux's report is even more devastating than his original survey. It tracks the outbreak using evidence that "strongly suggests" the epidemic emerged from the Nepalis' camp.
Where was the source?
Worse yet, Piarroux argues that it could not have come from a recovering cholera patient, or from an asymptomatic carrier. To infect users of water from the Meille and Artibonite rivers, the quantity of Vibrio cholerae would have to come from at least one seriously sick cholera victim.
This directly refutes the assertion of Secretary General Ban Ki-moon's spokesperson in Haiti, who had claimed "negative" test results on the Nepalis. Cholera is a spectacularly messy and smelly illness causing both diarrhea and vomiting, so everyone in the base would have known about it. Suppressing information about such an outbreak would have required the collusion of senior Nepali officers, MINUSTAH officials, and at least some healthcare professionals in PAHO and the MSPP.
The UN had originally said the source of the epidemic was unimportant compared to the need to fight it. Piarroux's report pointed out that knowing the source was critical to an effective response to cholera.
Ignoring this obvious point, MINUSTAH issued a press release saying the study had been followed "by many others... each with different possible scenarios." To my knowledge, no such alternate studies exist, and MINUSTAH didn't cite any. We have only the UN report and that of Piarroux.
So the Piarroux report is an indictment of the United Nations and its agents in Haiti, including PAHO, which is the western-hemisphere branch of the World Health Organization. The denials and press releases only aggravate the problem.
Who will believe WHO?
This means that even WHO's integrity is compromised. It was ridiculed for calling swine flu a pandemic in 2009, and criticized for allowing Indonesia to withhold virus samples of bird flu. Now WHO has exposed itself to a far more serious charge of suppressing vital information about the epidemic while it spread explosively through the whole island of Hispaniola, including the Dominican Republic.
When the next serious outbreak arrives, therefore, WHO's ethics and credibility will be in question. Governments, health professionals and individuals will all be justified in wondering what the real story is, and whether the scare is really a scam or a coverup. Such skepticism could cost lives. (The Tyee sent a draft of this article to WHO, but did not receive a reply.)
This is not a problem just for faceless bureaucrats in Geneva or some third-world country. Canada has been deeply involved in Haiti since the 2004 coup against Aristide. We have sent some of our best cops to train the Haitian police; two of them died in the quake. Canadian Forces went into Haiti after the earthquake in Operation HESTIA to deliver humanitarian aid. The Canadian government has promised almost a billion dollars in aid since the 2004 coup.
A Canadian, Nigel Fisher, is the UN's Haiti Humanitarian Coordinator, supervising UN projects and coordinating with the NGOs.
What's more, our last Governor General, the much-beloved Haitian-born Michaëlle Jean, is now the UNESCO special representative to Haiti. If the UN's peacekeepers, health experts and humanitarian coordinators are compromised by a cover-up, so is she.
So over 80,000 Haitian-Canadians must now wonder if their new homeland really cares about Haiti as much as it says it does. The rest of us have grounds for feeling the same way.
Old-fashioned incompetence
The UN didn't set out to make matters worse in Haiti. Importing cholera looks like old-fashioned incompetence, frosted with some misplaced political appeasement.
Someone allowed the Nepali peacekeepers to spend ten days at home while a cholera outbreak was going on. No one demanded that the soldiers be re-tested before leaving for Haiti. Someone allowed the sewage tank at the Meilles base to leak right into the river, and no one did anything about it before the new troops settled in.
If Piarroux is correct, one or more Nepalis had active, symptomatic cholera. Someone should know who they were, and who said what to whom about such cases. And someone must have known that the truth would come out, but chose to deny both Piarroux's initial report and this more detailed one.
The denial may have been in part to spare both the UN and the Nepalese government from embarrassment. Nepal has been exporting soldiers since the days of the British Raj, and in September 2010 it was supplying 5,044 troops on peacekeeping missions. The UN was reimbursing Nepal to the tune of US$1,028 per soldier per month.
Demand for infectious peacekeepers being zero, Nepal would therefore stand to lose over $5 million a month, and the UN might have trouble finding replacements.
The Piarroux report has certainly embarrassed all concerned, including the Canadians in Haiti who didn't protest MINUSTAH's denials. But it may well be swept under the rug anyway. The mere mention of Haiti induces instant donor fatigue. That's why most of the money promised for both earthquake relief and for cholera has dried up.
The current second wave of cholera cases has gone largely unnoticed in the North American media. This is convenient, because the resurgence shows how little the UN has done to eliminate the squalor that cholera thrives on.
Dr. Rupert Virchow, the 19th-century doctor and politician, famously said that "Medicine is a social science and politics is nothing else but medicine on a large scale." In the case of Haiti's cholera, Canada and the UN have committed malpractice on a very, very large scale.
Crawford Kilian is a contributing editor of The Tyee.
Source: The Tyee (British Colombia for News, Culture and Solutions)
__________________________
Thousands of Lives
Could Be Saved, and Haiti’s
Cholera Epidemic Managed,
With Greater Treatment
and Prevention Efforts,
CEPR Paper Finds
submitted by: theangryindian
Recent Cholera Spike Was “Entirely Predictable,” Yet Treatment Efforts Fell Off
For Immediate Release: August 18, 2011
Contact: Dan Beeton, 202-239-1460
Washington, D.C.- A new paper from the Center for Economic and Policy Research argues that cholera treatment and prevention efforts in Haiti have fallen woefully behind, leading to thousands of preventable deaths, even though the dramatic rise in new cases this spring and summer was entirely predictable. The paper, “Not Doing Enough: Unnecessary Sickness and Death from Cholera in Haiti”, by researchers Jake Johnston and Keane Bhatt, argues that it is not too late to bring the 10-month old cholera epidemic under control and save thousands of lives by ramping up treatment and prevention efforts.
“Haiti’s cholera epidemic has been much worse than it could have been, and thousands more people have died, due to an inadequate response from the international community, going back to when the outbreak began,” CEPR Co-Director Mark Weisbrot said. “It’s time to reverse course and get serious about controlling and eventually eliminating cholera from Haiti.”
“In July 2011, one person was infected with cholera almost every minute, and at least 375 died over the course of the month due to an easily preventable and curable illness,” the paper notes. A March 2011 article in the medical journalThe Lancet predicted that cholera infections would spike with the onset of the rainy season following a drop-off during the drier months of late 2010 and early 2011. Yet overall cholera efforts were scaled back just as infections were increasing: only 48 nongovernmental organizations (NGOs) were addressing cholera in July, down from 128 in January.
As predicted, new cholera infections increased with the onset of the rainy season this year, reaching an average of 1800 new infections per day in June – almost twice as many as in May and three times as many as in March and April, the paper notes.
The paper also notes that NGO’s and international agencies have targeted urban centers over rural areas, despite the anticipated spread of the disease to all corners of Haiti, and significantly higher case fatality rates in some rural areas. The department of Sud Est, for example, currently has the highest fatality rate, at 5.4%, but no Cholera Treatment Centers.
The authors recommend several ways in which the cholera epidemic could be brought under control -- and thousands of lives saved -- including expanding the reach of inpatient facilities in the hardest-hit areas, scaling up antibiotic and supplement treatment efforts, prevention and care through education campaigns, and a vaccination strategy. International donors also have fallen far behind on their pledges for cholera assistance.
The paper outlines a number of other factors that contributed to the severity of the epidemic, one of the most important being the relative scarcity of potable water in Haiti. The authors describe various ways in which public water systems have been under-funded and implementation delayed by the international community, while some donors have pushed instead for “cost recovery” water systems in camps for internally displaced persons (IDP’s) and elsewhere. These would require residents to pay for potable water, and likely lead to an increase in cholera infections as potable water would be put out of reach of IDP's and other low-income Haitians.
“Safe, clean drinking water for all Haitians should be a top priority for international donors,” Weisbrot said. “And if it had not been so neglected years ago, when loans for this purpose were blocked by the United States, the severity of this outbreak might have been drastically reduced.”
The paper’s lead author, Jake Johnston, added: “The money is there: the U.S. Congress appropriated $1.14 billion for Haiti a year ago, and most of that money has not been spent; and a lot of the $1.4 billion that Americans gave to private charities after the earthquake – including the biggest organizations such as the American Red Cross -- also remains unspent. And there are also hundreds of millions of dollars of international aid that were pledged by governments but not yet delivered. These funds can be used to expand treatment and prevention of cholera in Haiti, and to build the necessary water infrastructure.”
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