Introduction from Faith's book of photographs: Haiti/Kolera
On October 21, 2010, the first documented cholera outbreak in the history of Haiti began. It started like all cholera outbreaks start, people drank water contaminated with the bacteria Vibrio cholerae. A few people with severe diarrhea and vomiting quickly increased to a dozen people which quickly increased to hundreds and then thousands of people.
Until that point, Haiti had many problems, but cholera was not one them.
It is a horrifying disease that can kill a healthy adult in as little as four hours. Even a mild case can debilitate an adult with up to seven days of profuse diarrhea and there is no treatment that can stop the disease once it starts. Children, the elderly and pregnant women are even more vulnerable to death.
What makes it even more horrifying, is that cholera is entirely preventable. In the 1800s, every major city in the world had cholera outbreaks: Paris, London, New York, Boston. When Dr. John Snow was able to illustrate that water contaminated with human waste was spreading the disease in London, the world changed. Clean water and sanitation became a priority as we began to understand the number of diseases that were transmitted by ingesting human waste.
Only ten percent of Haitians have access to sanitation and only fifty percent have access to clean water. This, combined with repeated flooding due to storms and deforestation, created ideal conditions for cholera to bloom and spread.
On November 3, 2010, I traveled to Saint Nicolas Hospital in Saint Marc, at the epicenter of the outbreak. I found a country that was still suffering from the January 12 earthquake and trying to understand this latest horror while struggling to find normalcy. Children went to school, builders rebuilt, vendors sold their wares, women collected water.
I also saw the failure of the international community to face down the cholera outbreak. The failure to make available chlorine tablets and other simple, inexpensive water purification technology was shocking and disappointing.
This led me to start asking the question: how do you get clean water to 10 million people? I still do not have the answer, but I believe that it has to rely on the ingenuity and hard work of the people and their desire to improve their lives and the lives of their families, for good.
Saint Nicolas Hospital was a constantly shifting landscape with tents going up and then coming down. There were cholera patients in every corner of the hospital, in the cancer ward, in the maternity ward, in the children’s ward. There were tents in the courtyards with people sitting side-by-side slowing sipping rehydration fluids or holding IV poles and resting between bouts of diarrhea and vomiting. In the wards, patients were packed closely together with family members sitting at the edge of specially built cholera cots — simple bed frames with a tarp stretched over and a hole cut out of the center so that the patient did not have to get up for a bout of diarrhea. Mothers dried their children’s brows and fed them spoons of food, wives decontaminated and emptied waste buckets, brothers carried loved ones, slumping, dehydrated and dying, into the hospital.
The sight of family members, many without gloves, handling the cholera filled buckets, bleaching them and bringing them back to be reused, immediately made me worry that many of the family members I saw caring for the sick would be returning to the hospital for treatment themselves. When I asked the nurses, they said, yes, they did often see family members back again.
MSF, Doctors Without Borders, was running cholera treatment in the hospital, with the shell-shocked Haitian nurses looking after patients. I asked a doctor why they were not administering antibiotics to patients (which doesn’t stop the disease but can cut the length of the illness in half) and she told me that it was not MSF’s policy. When I asked the head nurse at Saint Nicolas, she told me that they did not have enough.
In the small hospital lab, the technicians carried on with their regular jobs. They administered pregnancy tests, malaria tests and HIV tests. They did basic tests for the MSF doctors to determine the best re-hydration for severely ill cholera patients. On Tuesday, the waiting area outside of the lab was full of mothers and small children with fevers and coughs, there to see the doctor.
Outside the hospital, people went on with their lives. Women walked down the road with water buckets on their heads, vendors sold brightly colored packets of sweets from stands and steaming hot fried goat from the side of the road. Men hawked bottles of water and Pepsi and cell phone cards. Construction crews tore down broken buildings and rebuilt them. In the midst of this growing outbreak, Haiti was alive with commerce and activity. I could not help but think that if the right tools were put in the hands of Haitians, they could stop this disease. What if every street vendor and shop owner had chlorine tablets and packets of oral rehydration salts? Could cholera be stopped then?
My short trip was only made possible by the help of many people. Above all, I am grateful to my PhD advisor Andrew Camilli for supporting my wild idea to travel to Saint Nicolas Hospital to collect patient samples.
I was lucky to find an exceptional partner in Madila Nezifort, the head nurse at Saint Nicolas Hospital. I tracked her down through the Ministry of Health. She accepted a random call from a group of researchers in Boston and agreed to let me come down to the hospital. When I arrived, she corralled her nurses to collect the samples and peered with curiosity into the microscope, seeing Vibrio cholerae for the first time.
Dozens of people took time out of their busy schedules to talk to me about their experiences working and traveling in Haiti and advising me on everything from food and water, local roads and transportation to fixers, drivers and translators.
Jim and Karen Ansara played a pivotal role by very kindly connecting me to Jean Lionel Pressoir of Tour Haiti. Tour Haiti provided me with a wonderful driver and translator without whom I would have been entirely unable to do my work. They not only assisted me with my work, but also advised me on conducting myself safely, told me their stories and the story of their country.
To all of these people, I am incredibly grateful.