Haiti’s progress in achieving its 10-year plan to eliminate cholera: hidden sickness cannot be cured

Since the beginning of the cholera epidemic in Haiti 5 years ago, the prevalence of this deadly water-borne disease has fallen far below the initial rates registered during its explosive outset. However, cholera continues to cause extensive suffering and needless deaths across the country, particularly among the poor. The urgent need to eliminate transmission of cholera persists: compared to the same period in 2014, the first 4 months of 2015 saw three times the number of cholera cases. Drawing upon epidemiology, clinical work (and clinical knowledge), policy, ecology, and political economy, and informed by ethnographic data collected in a rural area of Haiti called Bocozel, this paper evaluates the progress of the nation’s 10-year Plan for the Elimination of Cholera. Bocozel is a rice-producing region where most people live in extreme poverty. The irrigation network is decrepit, the land is prone to environmental shocks, fertilizer is not affordable, and the government’s capacity to assist farmers is undermined by resource constraints. When peasants do have rice to sell, the price of domestically grown rice is twice that of US-imported rice. Canal water is not only used to irrigate thousands of acres of rice paddies and sustain livestock, but also to bathe, wash, and play, while water from wells, hand pumps, and the river is used for drinking, cooking, and bathing. Only one out of the three government-sponsored water treatment stations in the research area is still functional and utilized by those who can afford it. Latrines are scarce and often shared by up to 30 people; open defecation remains common. Structural vulnerabilities cut across all sectors – not just water, sanitation, health care, and education, but agriculture, environment, (global and local) commerce, transportation, and governance as well. These are among the hidden sicknesses that impede Haiti and its partners’ capacity to eliminate cholera

Following Water in the Wake of Cholera: Relation, Coloniality, and the Poetics of Osmosis in Haiti's Artibonite Valley

Throughout the Haiti cholera epidemic, the Artibonite Valley region, which stretches across the middle of the country, saw some of the highest caseloads. In October 2010, toxigenic Vibrio cholerae, the bacteria that causes the deadly diarrheal disease, had breached a United Nations military base in central Haiti and entered a tributary of the nation’s most prominent waterway, the Latibonit (Artibonite) River. A confluence of structural factors and social forces linked to an enduring “colonial matrix of power” not only mediated these troops’ presence in Haiti, but also allowed for the pathogen-laden effluent to seep beyond the camp and for the exposure of millions of Haitians to contaminated water, sparking the nation’s first cholera epidemic and the deadliest in recent world history. Iterations of coloniality saturate people’s lived experiences of the outbreak as well as the social, religious, ecological, and visceral relations gathering in its wake. In this dissertation, these experiences and entanglements in several communities along the Latibonit serve as a point of departure for theorizing human-water relationality within Haiti. Using an interdisciplinary, multi-method approach that draws from my training as an MD/PhD student in medicine and sociocultural anthropology, I conducted more than 12 months of ethnographic fieldwork over the course of 2015-2019, accompanied by archival research in several digital collections. I based my studies in Mibalè, a central Haiti town downstream of the UN base; Sen Mak, a coastal secondary city near the mouth of the Latibonit River; and the Fifth Communal Section of Sen Mak, a predominantly rice-growing region bordered by the river. My findings locate cholera as not simply an acute, severe disease, but rather an enduring rupture that, like all ruptures, demands adjustments from those affected—the most salient concerning the waters people drink. How and why, with the occurrence of this epidemic, did relations between humans and drinking-water shift or persist? In Following Water, I attempt to situate when, where, and how these human-water disruptions occur and the ways in which Haitians are navigating their repair. Though the outbreak began with the leaking of toxigenic V. cholerae into the Latibonit River, the origins of the epidemic multiply within the context of colonial repetitions in Haiti and globally. Waters likewise multiply in their webs of connection, circulation, and flux. An orientation toward the waters both mediating the epidemic and linking pathogen and host is thus a future orientation toward the waters with which people become, and not just suffer from. Embedded in the unfolding of Haiti’s novel cholera epidemic—and the bodies of people it affected—are the recurrences of coloniality as well as creative ways for collectively surviving them. To trace these processes, I begin from the site where vibrios, water, and humans meet: the semipermeable membranes of cells lining the intestinal wall. Amid the cholera epidemic in Haiti, the confluence of vibrios, water, and humans happens not only at the cellular membrane, but also at the semipermeable membranes of reverse osmosis systems increasingly used throughout the country in the wake of the outbreak. By following drinking-water, river water, diarrhea, rice-water, and reverse osmosis water, my thesis explores how membranes—and the osmotic processes they mediate—trouble such alleged binaries as the natural and cultural, human and nonhuman, past and future, ordinary and exceptional, bodies and technology, death and (forms of) life.PHDAnthropology PhDUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/176665/1/vkk_1.pd

Cholera in Haiti: informing health policies

The worst cholera epidemic in recent history began in Haiti in October, 2010. By August 2012, more than 7500 people had died and almost 600 000 cases were recorded. Published research and a UN investigation suggest that the UN military mission, MINUSTAH, was the most likely source, caused by failures in medical screening and waste management. The UN has not used these findings to update its policy. We postulate that this was partly because UN officials might be unable to understand the data. Helping UN officials to comprehend the data could enable quick, evidence-based protocol reform. We investigated knowledge and interpretation of scientific reports by UN officials. We searched PubMed for articles published between October 2010, and June 2012, with the terms “Haiti” and “cholera”. Only original research about the origins of cholera in Haiti were included. Of 103 articles found, seven met this inclusion criterion. We also included data from the UN report. We supplemented our PubMed search with discussions with the authors of the identified reports. We provided scientific briefs to UN officials who responded to the cholera epidemic. We met with 23 UN officials, including permanent mission representatives. We asked officials if they saw a need for translation of scientific findings, found briefings helpful in shaping policy, and could foresee briefings influencing policy recommendations. 21 officials expressed difficulty understanding the scientific data and said that they would appreciate help interpreting results. All asked questions about the published research that they felt were not answered by lay media reporting. None had read any original articles, although 20 had read excerpts from or all of the UN report. Every official reported an improved understanding of the origin of cholera in Haiti after a briefing. 16 officials thought that our briefings could help shape policy. All officials felt that regular communication between scientists and policy makers was essential to inform policy changes. 21 officials stated that they had not been previously approached by the scientific community to assist them with interpretation of the data to help guide policy reform. A comprehensive response to and prevention of epidemics requires collaboration between researchers and policy makers. In the Haiti cholera epidemic, the scientific community and UN officials were addressing a common crisis but working independently. Partnership between science and policy needs proactive, independent researchers who seek out policy makers and help them to interpret scientific data. Almost 2 years into the cholera epidemic, the UN has not updated any of its medical or waste policies. If more people can help UN officials to understand scientific findings, the UN might speed up updating its protocols, which could save the lives of UN staff and the people they serve. None