How we're fighting cholera in Haiti
In April of 2016, Bozil Anouce got cholera. Anouce, better known as Wowo, is the night watchman at the MCC Desarmes office. He can’t remember exactly how long he’s worked with MCC, but his best estimate puts it at almost 30 years. After getting sick, Wowo tried to carry on tending his gardens and animals as usual, but eventually it became too much.
“It attacked me,” he remembers. “I couldn’t eat, I was sweating, my heart was racing, my stomach was boiling.”
Wowo was not alone in his suffering: after Hurricane Matthew struck Haiti on October 4th, 2016, cases of cholera spiked around Haiti, especially in the Artibonite valley, where Wowo lives. The high mountain communities, exposed to the elements and hours away from the nearest hospitals, are especially vulnerable to the consequences of disasters, including wind damage, flash flooding and landslides.
However, not all the hardships faced by the people of the Artibonite after Hurricane Matthew were caused by nature. Cholera is a fast-acting water-borne disease spread by contact with infected human waste. The disease was introduced into the Artibonite River by UN peacekeepers who failed to properly dispose of their waste in 2010. Cholera has been present in Haiti ever since, and although the rate of infection has decreased steadily at a national level since the initial outbreak, the disease emerges with renewed vigor after heavy rains. In the fall of 2017, members of the medical community serving the Artibonite began to note with increasing concern the sharp rise of cases of cholera, and began calling it a cholera epidemic.
Cholera, while easily treatable through rehydration and antibiotics, can kill within hours if that treatment is not received, which is often the case in remote communities. The journey to the community of Wopisa is just one example of the grueling trek that can take a person between four and six hours to walk, and at one point requires scaling a waterfall. By the time a person sick with cholera descends the waterfall to the hospital, often carried on the backs of friends and family members, it may be too late.
After Hurricane Matthew, anticipating a significant increase in cases of cholera in the Artibonite, MCC quickly implemented plans with local partners both to stop cholera at the source in communities like Wopisa, and to support effective treatment for cholera patients at the Zanmi Lasante Cholera Treatment Center in the town of Verrettes. Zanmi Lasante is the Haitian branch of Partners in Health.
In the remote community of Wopisa, MCC, in partnership with local leaders, has supported community members in the construction of 450 latrines since Hurricane Matthew. (Learn more about latrines in Haiti). Building latrines can be a simple and extremely effective way to curb the spread of cholera in remote communities. In addition to supplying participants with the basic materials—a cement base, a PVC vent pipe, and a tin roof—a public health nurse provides training on cleaning and maintaining the latrine. Because community members no longer need to practice open defecation, when heavy rains wash soil from the mountainsides into water sources the likelihood that soil contains infected human waste is dramatically reduced.
In communities where MCC has implemented this model of latrine-building and education, zero cases of cholera have been reported in the two rainy seasons since Hurricane Matthew. Normally during the rainy season, anywhere from 200 to 400 cases of cholera and acute diarrhea would be expected with up to a dozen fatalities. This is especially remarkable as other mountain communities in the same area continue to find themselves in the midst of the new cholera epidemic that began this fall.
Eventually, after a week of suffering in silence, Wowo told someone that he had cholera. He approached MCC Desarmes program coordinator Jean Remy Azor who immediately sent him to the Cholera Treatment Center in the nearby town of Verrettes. There, Wowo spent four days receiving rehydration solution and antibiotics.
The Cholera Treatment Center in Verrettes, run by MCC partner Zanmi Lasante, was initially constructed as a temporary response to the initial outbreak of cholera in the Artibonite in 2010. However, it soon became clear that the cholera in Haiti was not going away any time soon. After Hurricane Matthew, MCC supported Zanmi Lasante to completely rehabilitate and expand the center to address the post Hurricane spike in cholera cases.
In order to create a more effective and sanitary treatment center for future patients, the number of showers and toilets were increased, waste and water treatment systems were implemented and sanitation protocols for staff and visiting family members were updated. By providing more efficient and effective care for over 130,000 people in the Verrettes catchment area, MCC and Zanmi Lasante are ensuring few people die of a disease that doesn’t need to be fatal.
After Wowo was released from the Cholera Treatment Center, a team from the center visited him at home to disinfect his yard, provide him with water treatment tablets, a bucket for treated water, and training for him and his family on cholera prevention. Wowo suspects he got cholera at home, and has eagerly implemented the information he received from the medical team.
“Now, at home, I’m always looking around for anything that could have contaminated water,” he says.
Wowo received treatment for his cholera, and has recovered. He has returned to tending to his garden, animals, and his work for MCC. He knows the acute suffering cholera can bring and thinks of his fellow community members in the center of the current cholera epidemic when he says “I hope these sicknesses will not return again…”
Annalee Giesbrecht is from Winnipeg, Manitoba and is currently serving as MCC Haiti's Communications Assistant. She has a degree in English from Canadian Mennonite University and is trained as a graphic designer.