Opinion

How We Helped Pave Haiti's Road to Cholera Hell

Canada and the UN have committed public health malpractice on a very large scale.

By Crawford Kilian, 7 Jul 2011, TheTyee.ca

Cholera aid workers in Haiti

Ambulance drivers take critically ill patients, referred by the Red Cross, to a cholera treatment centre. Credit: Amanda George/British Red Cross/Creative Commons.

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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.  [Tyee]

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