The panic began to set in after Tropical Storm Isaacs rains had subsided and the sun finally began to shine on this storm-damaged beachfront hamlet. Frantz Pierre-Louis, looking at the trail of fallen trees and flooded farms confronting him, had something much more pressing on his mind.
We have to prevent a cholera outbreak, Pierre-Louis, sitting in his pick-up truck, said, his voice filled with urgency.
Just when Haiti thought it had cholera under control, Tropical Storm Isaac came along. The storm left at least 24 dead in Haiti, and reignited fears that the floods and rains could accelerate a peak in cholera deaths and infections. Even worse, the deadly diarrheal disease could spread to the sprawling tent cities in Haitis capital where 390,000 victims of the January 2010 earthquake still live and where until now it has remained at bay.
Today with the situation in the camps, it is clear they are most at risk, said Yolette Etienne, Oxfams program director, alluding to the lack of potable water in camps.
Last week, U.N. Secretary General Ban Ki-moon told the U.N. Security Council that living conditions in many of the 575 camps have deteriorated to the point where Haitians remain extremely vulnerable to cholera, and the governments Health Ministry is unable to effectively address a crisis on its own.
The resurgence of the cholera outbreak is particularly worrying since non-governmental organizations, which responded at the beginning of the epidemic, are phasing out due to lack of funding, Ban said.
We can assume there is going to be an increase in patients, said Oliver Schulz, Doctors Without Borders/Médecins Sans Frontières (MSF) country manager, from inside a cholera treatment center in the Port-au-Prince suburb of Delmas, where post-Isaac patients had begun trickling in. The storm increases the risk.
This is especially true in flooded communities, where the drinking water is at risk of becoming contaminated by wastewater from latrines. Along Route 9 near the Cité Soleil slum in the capital, for example, a nearby river flooded about 1,200 homes, turning front rooms and yards into chocolate-colored lakes.
Diana Victors family house was among those that were flooded, the young woman said, sitting on a cot at an MSF cholera treatment center. Weak and her voice barely audible, Victor, 21, said she has no idea how she contracted cholera.
I didnt drink any water, I only walked in it, she said, the day after she showed up at the treatment center on the back of a motorcycle taxi covered in vomit and clear-colored diarrhea. I didnt feel well at all, I couldnt stand, couldnt eat.
Schulz said while cholera is easily preventable, it is also easy to get, especially when heavy rains and floods limit access to clean water.
You might have a nice distribution of soap for instance, but if you dont have clean water to wash your hands, the soap is useless, he said.
The annual Atlantic hurricane season, which runs from June 1 to Nov. 30, has become a dreadful reminder of not just how environmentally fragile Haiti is, but how susceptible Haitians are to contracting cholera, the deadly waterborne epidemic that arrived in Haiti two years ago next month.
Nepalese U.N. troops have been accused of bringing cholera to Haiti after the Artibonite River, located near the troops latrines, became contaminated with the cholera bacteria. On Wednesday, more than a dozen human rights groups are expected to issue a letter renewing calls for the U.N. to make clean water and sanitation available in Haiti to help curtail the cholera crises.
Cholera has killed more than 7,500 Haitians and sickened more than 588,000 in what some describe as one of the worst epidemics in recent years. The number of cholera cases international medical aid groups, such as MSF, treat in one day is an epidemic in some African nations, said Schulz, noting that MSF has already treated 12,000 patients since January.
Thats a full blown state emergency for many, he said.
Within days of Isaacs passing, MSF reactivated cholera beds cots with a hole in them at three of its four cholera treatment centers in the metropolitan Port-au-Prince area. Another group, Boston-based Partners in Health, put staff on notice and relocated supplies from the capital to rural areas where many lack access to potable water and health facilities.
Dr. Louise Ivers of Partners In Health, which just completed a pilot cholera vaccination program in Haiti, said the group has yet to see a spike. But she remains deeply concerned about the epidemics impact.
Haitis Health Ministry statistics show that although the number of cases is significantly fewer than this time last year, Haitians continue to die at an unacceptable rate.
The proportion of people dying is in some areas higher than before, Ivers said. What it says, she added, is that there is a continued lack of access to quality services in some areas. In theory, no one reaching a hospital should die of cholera.
Health Minister Florence Duperval Guillaume said the government is equally concerned about cholera-related deaths as well as infections. Before Isaacs late night arrival here, the ministry ordered all government hospitals and clinics to remain open for 24 hours for at least four days after the storms passing. Hospital pantries, Guillaume said, were stocked with chlorine tablets, bottled water and oral rehydration salts.
All is well positioned for the prevention and care of patients, Guillaume said.
In addition to stepping up surveillance for new cases, health officials are working with a number of aid organizations such as Oxfam to scale up cholera response. Oxfam is currently rehabilitating dozens of damaged oral rehydration salts stations in the capital and making repairs to broken drinking wells in the Artibonite River.
Dr. Arthur Fournier of Miami-based Project Medishare said the Central Plateau, which was spared most of Isaacs wrath, also hasnt seen an uptick and the aid group hasnt reopened any of its treatment centers so far.
Were holding our breaths, he said.