Friday, November 26, 2010

The Haitian Cholera Outbreak: Of Nepalese Origin?

A Haitian suffering from cholera near Cap Haitien. Note the drawn, gaunt facial featues, typical of this disease which kills by massive dehydration (combined projectile vomiting and liquid diarrhea) within 24 hours or less.

In many parts of the media the beleaguered Haitian people are being depicted as conspiracy theorist crazies for blaming the UN’s Nepalese Peace keeping contingent for the cholera spreading there. These critical media insist that Haiti’s wrecked infrastructure (from the earthquake), poor water resources and crowding are the more likely source.

But not so fast!

Investigations by the Associated Press have found the Nepalese peacekeepers did have a base on the Artibonite River where the outbreak originated. Sanitation at the base was supposed to be handled by a private company, Sanco Enterprises, SA- which won the contract by underbidding a rival.

The septic tanks used were to be emptied once per week, but when the AP visited Oct. 27, a tank was clearly overflowing and “the back of the base smelled like a toilet had exploded”. The AP reported “dark, reeking liquid flowed out of a broken pipe toward the river from the latrines

UN military police seen taking samples were “clearly horrified”. Meanwhile, Haitian neighbors also reported a Sanco driver dumped waste in an area outside the usual repository pits.

The fact that the effluent from the broken pipes and overflowing tanks ran right to the river was evidence to many Haitians that the episodes at the base camp were the primary causative agents in the cholera outbreak. Their view is substantiated by other facts that have since come to light, including:

-the fact the latest Nepalese deployment came in October, after a summer of cholera outbreaks in Nepal

- The CDC (Center for Disease Control) identified the strain of cholera in Haiti with one that matched one originating in South Asia

- Though the UN claimed none of the Nepalese peacekeepers showed signs, this actually proves nothing since 75% of those infected with Cholera never show symptoms- but they can still pass on the disease for 2 weeks (especially in nations like Nepal where the population has developed an immunity because cholera is endemic)

- Before last month, there had never been a confirmed case of cholera in Haiti, since according to CDC health officials “there were no cholera bacteria there”.

In effect, no matter how deplorable a nation’s water delivery systems or resources, or the amount of filth, cholera cannot occur unless the bacteria are there. If not there originally, it needs to be introduced from outside.

Enter the Nepalese, some of whom were likely infected but asymptomatic – and who spread the infection when they used their latrines and the septic tanks leaked and pipes broke – sending the infected waste into the Artobonite River where vulnerable Haitians ingested it.

Of course, the UN – with its ass hanging out in a sling, has tried to spin away from that conclusion. For example, it acknowledged the reeking black liquid was overflow from the Nepalese base but insisted it was kitchen and shower waste (making one wonder what kind of grime could produce an odor analogous to a “toilet exploding”) What were the Nepalese peace keepers doing, playing in shit?

Another spin move was the UN insisting none of the Nepalese “had shown signs of cholera” which many news outlets misreported as claiming the soldiers “tested negatively for it”. But as we know, cholera can be present but asymptomatic in 75% of the population, especially from a county in which cholera is endemic so the populace has immunity. The media ought to be reprimanded for conflating an absence of signs (evidence of absence is not absence of evidence) with an actual test to verify the absence of outward signs equals absence of cholera.

When one strips away all the red herrings, misreported crappola and distractions there is likely only one conclusion on the cholera’s origination, as articulated by Prof. John Mekalanos, the Chairman of the Micro-Biology Dept. at Harvard University:

It very much likely did come with the (Nepalese) peace keepers or other relief personnel. I don’t see there is any way to avoid the conclusion that an unfortunate and presumably accidental introduction of the organism occurred.”

Lest one hastily seek to blame the Nepalese soldiers, let us bear in mind it was the private septic tank company, Sanco, which actually dropped the ball: by not emptying the septic tank in a timely fashion, thereby letting it overflow and not repairing a broken pipe, sending cholera-infected waste to the river Haitians used for bathing and drinking.

Thus, the Haitians are correct in claiming the outbreak originated with the Nepalese camp, but not correct in blaming the Nepalese peace keepers for instigating it. They need to direct their ire at the private, underbidding company that cost them their lives, health and mental well being. (Though the company will likely deny it – but the AP reports are very convincing regarding their culpability.)

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