Fighting Cholera—and Fear—in Haiti

Daniel Henrys, M.D., discusses some of the challenges he and other public health practitioners have faced following the 2010 earthquake and subsequent cholera epidemic in Haiti. Since October of this year, more than 3,000 people have died of cholera in Haiti.

About two hours before the earthquake struck, I was at FOKAL, the Open Society foundation in Haiti, participating in a discussion of health issues. Many organizations, almost all of them foreign, provide health services in the area around Parc Martissant, which includes some of Haiti’s roughest slums. Residents need better coordination of these organizations’ efforts. So we were beginning a project to bring more public support behind efforts by the local community public health bureau, whose function is to coordinate health intervention.

The earthquake delayed the project’s launch until October 2010. Two weeks after the launch, a cholera outbreak began claiming victims in the Central Plateau and other districts. By December, five people had died of cholera in the community around Parc Martissant. We could have a widespread outbreak of cholera in the area around the park at any time.

FOKAL’s mission is to strengthen the sense of community around Parc Martissant, an area where mistrust and violence make inhabitants fear speaking with one another. Fighting cholera demands community involvement. In the first public discussion at Parc Martissant after the cholera outbreak, everyone was talking about the disease. It was emotional. Some people were blaming the United Nations. The community health bureau had been pushed aside after the earthquake, and the project’s efforts to galvanize a community response community began giving the bureau an opportunity to reestablish its authority in coordinating medical responses and improving efforts to fight malnutrition and tuberculosis, HIV/AIDS, and childhood diseases and to improve nutrition.

Many Haitians mistakenly believe that our natural resistance to infectious disease is strong. Many of them say it is not possible for Haitians to die from infectious diseases. So when the cholera struck, many people believed that it had been introduced on purpose. Voodoo priests have been killed on the Central Plateau and in the country’s southwest. Here, every time you have an epidemic, people attribute the outbreak to supernatural causes or to someone taking revenge. Probably some people affected by cholera went to a priest and died. The interpretation of the family was that the priest killed the victim and the people killed some priests.

I fielded many questions during the meetings at Parc Martissant, and had to explain that the disease is transmitted by water. The participants wanted to know how to prevent infection. For cholera, prevention involves individual hygiene, for example, washing hands, drinking chlorinated water, and safe disposal of excrement. But this is not so easy to practice. For washing your hands you need water, and this is a problem. Chlorinated water is a bigger problem. And excrement you can’t just put it in plastic bags, dump it in a stream, and have the rain wash it away. This is commonplace practice in the slums around Parc Martissant.

We have worked with the local community public health bureau to help it define its mission in order to improve coordination of health care activities. The project has begun to identify the organizations working in health care in the area around the park. Haiti’s Ministry of Health has defined a health minimum package all people should enjoy. We have tried to determine whether the area’s health care organizations are meeting this minimum. Our goal is to create a network that will meet the standard. We are also working to strengthen the capacity of community groups to improve public awareness that health care is a right.