Tag Archives: haiti

Chasing Cholera in Haiti

This post was originally published on Medium.com on Mar 29, 2013.The deadliest river in Haiti

It was February 25, 2012, and I was tracing cholera’s path around Haiti, trying to understand how a disease so treatable could kill so many people. A cholera outbreak could never happen in Miami, all the experts said, but I didn’t understand how a bacterium could discriminate against who it would infect and kill, and why it was picking Haiti of all places to do this.

Silver bursts of sunlight caught my eye at irregular intervals as we wound around the bends of the Artibonite River on our way from Saint-Marc to Mirebalais. At 320 km long, the Artibonite is the longest river in Haiti. It provides the 1.2 million residents of Haiti’s capital city, Port-au-Prince, with hydroelectric power, making it the most powerful river in Haiti. And ever since the Nepalese faction of the United Nation’s military operation infected the river with cholera by improperly disposing of their infected waste, it has been the deadliest river in Haiti.

Artibonite River Dam, Haiti, Arikia Millikan

Whenever Americans hear that UN peacekeepers brought cholera to Haiti for the first time, they’re skeptical. But we know that’s where it came from because the Vibrio cholerae bacteria responsible for the outbreak has a genetic fingerprint, just like we all have fingerprints that distinguish us as individuals, and that particular strain came from Nepal. That’s where the troops were from who were stationed at the UN base directly upstream from the location of the first documented cholera case in Mirebalais.

Since the first case of cholera was documented in October of 2010, the disease has killed over 8,000 people and infected 649,000 others — over 5% of the population. When I was in Haiti in the spring of 2011, there had already been 4,672 cholera deaths. Health organizations were circulating information about the disease in hopes that simple awareness would curb it. Cartoon figures on concrete fences smiled patronizingly at pedestrians walking along rubble-littered streets, explaining how to properly wash one’s hands. There were rumors of advice whispered amongst the bourgeois: “Don’t eat the salad at such-and-such place, someone got sick because they washed the lettuce with contaminated water.” “Stay away from seafood, because, you know.”

Cholera PSA Haiti

In Port-au-Prince, there is no public water system — no infrastructure of pipes connecting residences to a main supply. But there is access to treated water, if you can afford it. Drinking water comes in jugs like the kind you’ve probably seen in offices attached to a conical paper cup dispenser. You drink it, rinse dishes with it, and use it to brush your teeth. Sometimes when you’re walking or driving around outside, you hear the high-pitched mechanical tunes that in developed countries signals an ice cream truck is near. In Haiti, it means the water truck is near. Little kids and adults alike chase after the truck, pay a few cents and receive a clear plastic baggie of water they carefully break open with their teeth or poke straws into to hydrate.

The Water Truck Haiti

There’s a different kind of water for bathing. It’s treated with bacteria-killing chemicals in a much cruder way. Some people have reservoirs underground to store it, and pumps to circulate it through pipes and out of faucets — if there happens to be electricity. Electricity from the main grid comes and goes in an unpredictable fashion. Forget about heated water. Without electricity, the pumps can’t circulate the water, which means bucket showers. You never, ever want to drink this water. The eyeballed methods of chlorination are unreliable. Too little and the reservoir is subject to microorganisms, too much and the chlorine leaves your skin with an itchy burn after your freezing bucket shower.

Many of the victims of cholera, I later learned, were too poor to afford these luxuries.

The car pressed on around the river, tracing the spread of disease from the first documented case, to the site of the first massive outbreak. Along the way, we passed several banners reprimanding the UN for bringing cholera to Haiti.

With me was Paul Clammer, the British documentarian who wrote all the major guidebooks to Haiti in the past decade. Our driver, Edzer, was a former member of the Haitian police force who had retired to go back to school to be a social worker. To earn money, he translated for journalists and helped them get around in Haiti. His laid back smile made him seem like a big teddy bear, but when a street vendor popped out of nowhere next to the car startling us all, his reflexes in hitting the lock button told me he was a teddy bear who could kill someone in two seconds if he had a reason.

We were driving along the path that Jon Lascher, the Haiti Program Manager for Partners In Health, had directed us to take to meet him at the new teaching hospital in Mirebalais. He had just taken us on a tour of the hospital in Saint-Marc that had once been filled far past capacity with cholera victims, their bodies all violently expelling fluid in attempt to rid themselves of the toxin-releasing bacteria that rapidly replicates in the low acid environment of the small intestine. The Vibrio cholerae bacterium doesn’t kill people directly — its goal is merely to exit the body and spread to new hosts. When people die from cholera, they actually die from dehydration.

A Cholera triage center

This is the ironic tragedy of the disease. Nobody should ever die from cholera because the solution is so simple: rehydrate. The miracle treatment that patients get when they go to the hospital for treatment for a cholera infection, is something called “Ringer Lactate”. It is essentially salt water. A standard package costs about $1.50. But for most people in Haiti, this luxury is simply unavailable.

As we drove, Jon texted me that there would be some scenic views of the Artibonite river as we got closer to Mirebalais, and asked where we were. I texted back that we had passed a town called Verettes 15 minutes ago. There were no stores or other landmarks along the way, just houses here and there — floorless concrete walls painted in cheery pastels with various plant life thatched over top to protect against the harsh sun and relentless downpours of the rainy seasons.

The rainy seasons, peaking in May and October, are when the cholera cases spike. Just when the epidemiologists grow hopeful that all the efforts of the public health workers have finally managed to quell the outbreak, turbulent storms rip across the country, mixing infected water sources with clean ones and enabling cholera’s transport far and wide, all over again.

I was staring out the window, looking at that treacherous river and thinking about all this and how horrible it would be to die that way, when I started noticing people walking along the side of the road, carrying massive loads of things atop their heads as Haitians do. I wondered how long it would take them to get where they were going, since we’d been driving a long time through a whole lot of nowhere. I noticed some of them were carrying big jugs of water, and I felt so bad for them because water is so heavy and they had to carry it so far since there were no stores for at least 15 miles.

“Edzer, where do you think they’re getting that water from?” I asked.

“I don’t know,” he said after thinking about it for a minute. “I hope not the river.”

“No, they know that river is contaminated,” I said. “We have to find out.”

Edzer pulled the car over and we all got out and started walking in the direction the people were moving. We caught up with a young woman and Edzer introduced himself and asked her where everyone carrying water was coming from. “La Source,” said the woman, who said her name was Michou Felix. We didn’t understand. She pointed down into the brush beyond the road. We asked if she could show us, and she shrugged and agreed. We walked down the street for a few minutes until she pointed out a break in the brush. She led the way along the path, down far away from the road into a shady grotto. It started to get muddy, and we passed an opportunistic wild pig basking near a puddle. Nearby, a chicken pecked the ground.

“La Source,” Michou announced with a wave of her hand. Paul and Edzer and I all looked at each other with different forms of surprise. In front of us was a twisted bunch of exposed tree roots out of which a natural spring was trickling fresh water into a puddle far more shallow than your average kiddie pool. A man was standing on a root off to the side, patiently holding a plastic container below the trickle to fill it up while his three kids played off to the side. He had another plastic container with blue liquid in it.

“Is this their drinking water?” I asked Edzer to have him translate. It was, indeed, the sole source of drinking water for the surrounding community, where people mostly worked farming sweet potatoes, bananas and peas. Michou estimated this measly spring supplied the water needs of 5,000 people. She said some people treat it with “detergent,” the blue liquid the man was holding containing anyone’s guess about what cocktail of chemicals it contained.

“Aren’t they worried about cholera?” I asked. Edzer took a deep breath and translated. Michou shrugged the most helpless shrug anyone has ever shrugged in the history of the world, and responded in Kreyol. Edzer turned to me and said, “This is what we got to drink. It’s the life we have.”

“But, what are they going to do when the rainy season comes? What if the river contamination seeps into their spring?” I asked. He didn’t turn back to her, but instead leaned in closer to me. “They live under the fate of God,” he said. “If you kept asking them about it, they would say, they live under the fate of God.” We thanked Michou and gave her some money, then headed back to the car. It finally all made sense. That was real Haiti. That was how most people outside the city lived, with their most important resource transformed into a roulette wheel of excruciating death and disease. When cholera struck communities like that, seeping into their drinking water reservoirs then crawling from family to family as people tried in vain to treat their sick, there were no simple rehydration mechanisms. The public health task at hand, to make clean water and sanitation systems accessible by communities like Michou’s, would take decades, if it could ever be completed at all.

As we walked back to the car along the road, I was blinded by the irony of the situation where on one side of the road was a massive river, overflowing with the most precious commodity on the island, but to drink from it likely meant death. Meanwhile, the all-but-hidden spring on the other side of the road was trickling groundwater at a rate that the average American wouldn’t have the patience to fill a bathtub with, and was supporting a community of 5,000 people.

A cholera outbreak could never have spread in Miami, the experts all said. I now understood why.

Tuning out

I’m riding in the back seat of my aunt’s SUV, swaying along dark country roads while I try to focus on what I need to do to ensure my survival across the Atlantic this winter. She chats with her friend from down the street and my cousin next to me in the back seat talk about this television show and that, and I may as well be an alien in a pleated skirt and lipstick posing, poorly, as a suburban human. They talk about the newest episode of blah-blah-blah as I sit quietly, watching the rain cling in droplets to the window, grudgingly fracturing off into various paths and I think of Jeff Goldblum flirting with Laura Dern and chaos theory. They discuss which actress was good and which was bad while my mind drifts back to something my aunt said over dinner: about why the public discourse has shifted so drastically to the Syrian refugees when the Haitians have been coming over in boats and drowning trying for decades; about why there is such a debate about helping the Syrians when we haven’t even helped our next door neighbors living in the worst poverty one can imagine, before the subject was strategically changed by her friend who is of the opinion that politics should be avoided during meals and especially meals with family members from New York. I overhear so-and-so won the Emmy for something as I stare off into the woods watching the trees slice through the floodlights of faraway houses, and I am back in Haiti smelling the burning garbage and feeling my combat boots rub my heels raw while I walk with the author of the Lonely Planet Guide to Haiti for miles, past the markets where the sellers tirelessly flip the produce and descriptionless pharmaceuticals stuck to cones that brings in the $2 they need to survive for the day. They laugh at the screen death of a B-actor but I am standing with my nonchalant little sister over a mass grave filled with the bodies of victims of poverty, of America’s refusal to take responsibility for the power it has accrued, which led to the lack of help for our neighbors near and far, which led to the lack of stable concrete that burst into powder and smothered everything and everyone beneath it the fraction of a second the tectonic plate nobody had ever thought was a risk slipped beneath the hellish island from where my life snapped into existence on this plane. I exhaled sharply.

“Riki, are we talking to much about TV?” my aunt asks.

“No,” I say pleasantly and smile, loving her so much it overrides my building anxiety over the futility of our day’s events to change any bit of what is wrong with things.

“Are you thinking about all the work you have to do?”

“Yeah.”

On Fun In Haiti

Lots of people have fun in Haiti. A little-known secret about Haiti is that it is fun. It is easy to have fun, and too much of it if you’re not careful. Especially if you tend to abuse power, like drinking and driving, prostitutes, and general anarchy. If you don’t like those things, which I tend to not (save a little anarchy here and there, and beers-to-go when I’m in the passenger seat (which is always)), fun comes with a side of guilt.

This is because fun is a luxury. A luxury you are viscerally aware of when the majority of people you see every day are not having fun, they’re just “getting by.” This is because you must have money to have fun. I don’t consider myself as “having money” when I’m home in New York, so much as “getting by,” but here in Haiti I “have money.” And I feel damn guilty about it.

When I’m in a cab and the meter is running, I know it’s exactly the same price as a cab is in New York. When I go out to eat, the prices on the menus where I’m taken are the same prices on the menus at the places I frequent in New York. But it all feels more expensive, since here I’m in the maybe 5% of people of who have access to those things, and in New York I let other people pick up the tabs.

When I drink here, though, it feels cheaper. Beers are $2 or $3 here, whereas in New York, they’re $5-13. Maybe drinking is the global equalizer.

Tonight I drank some rhum Barboncourt, the national drink of Haiti, for the first time since the last time I was here. I banned myself from it after the night I allowed some UN guys to take me out to hear a Cuban band play at a local bar. I drank four “rhum punches,” a drink that is basically the Long Island Iced Tea of Haiti, where who knows what goes in it except a shit-ton of rhum and something that masks the taste.

I threw up when I got home that night and the whole next morning and afternoon. I don’t know if it was because I was dehydrated, or because when we left the bar and walked past the rows of tattered tents filled with displaced earthquake victims set up in the park across the street, the sick reality of the situation in Haiti hit me.

The UN guys I went to the party with were talking loudly and laughing when we walked out of there, reliving the fun highlights of a night that took place far away from any poverty or suffering. As we walked past the security staff, onto the street where we were only feet away from the tents, I shushed them.

“People are sleeping over there,” I hissed at them.

“Oh right, sorry,” they whispered back, with the concern of teenagers spending the night at a friend’s house after being reminded to not wake their parents, even though the parents know damn well there’s a slumber party going on and neither of the two parties is overly concerned about it.

They were here to help. They’re all here to help — the NGOs, the missionaries, and the Haitian bourgeois who so graciously contribute to the Haitian economy and create jobs. That’s what they tell themselves, and that’s what they believe. And because they’re here helping, working hard in this destitute country to lift the poor out of their unfortunate conditions, one by one, they’re entitled to a little goddamn fun at the end of the day.

So cheers to you, saviors of Haiti. Have fun. And when someone mugs or murders you or one of your friends in the street because they’re so fucking sick of hearing about how you’re there to help them while you and your kind walk around living life the way you’re accustomed while they’re starving and dying, then maybe Haiti can get some post-earthquake press while the rest of the world shakes their heads and mourns your tragedy, and the tragedy of why Haitians can’t just be civilized and accept the help they’re given.

The Blood of Christ

Last night I met some of my Haitian journalist friends for beers at a new-ish restaurant/bar spot in PetionVille, the neighborhood in Port-au-Prince where I’m staying with my family. When we were through plotting our weekend excursion and ready to head out, my friend found me a ride with someone he knew at the restaurant who lives just past me.

Nobody ever taught me to not take rides from strangers, and my instincts about doing so have never served me wrong. But that’s irrelevant.

My new friend and impromptu chauffeur was also giving a lift to a woman who had been drowning any possible Ash Wednesday resolutions with fury at the bar. She had natural-looking but not natural blond hair, and the kind of plumpness that occurs when you spend the majority of your life close enough to a Burger King to eat it multiple times a week but not so close that it ever cycles out of your favorite foods list. When our driver introduced us, she lunged for my hand to shake it with a smile so big and unwarranted that I pulled my hand back a little prematurely, or maybe she held it a little too long.

I’ve seen those smiles before. It was the same smile that the woman in the group of badly-sunburnt Midwesterners wearing matching shirts shone on me in line for airport security when I was flying out of Port-au-Prince last time when she asked, “and what group are YOU here with?” It was the smile that instantly evaporated and turned into a slightly horrified grimace when I replied, “I’m not with a group.”

Sure enough, the Burger Queen soon revealed she was a missionary with the Methodist church. “Oh yeah? That’s interesting,” I said. “What’s your mission?”

Slurring her words, she cheerily told me her job is to be the beach head for incoming Methodists to Haiti, helping them with the logistics of renting cars, finding lodging, and organizing outings for them in town. I asked if she showed them the way to the bars as well. She said no, that was her own personal mission.

We pulled up to her residence and she poured out of the car. She said goodbye, then swayed and struggled with the gate. The driver said he’d wait for her to get inside, but she insisted that he go on. When she realized he wasn’t going to leave her there until she got inside, the gate magically opened. I turned around as we pulled away, half expecting to see her sprint across the street to another bar to continue her repentance to God — which isn’t to say that she didn’t.

I for one, am touched that there are people so kind and devout in their servitude to God that they would drink his blood all night on Ash Wednesday to better help His poor children of Haiti.

First World Problems in Third World Countries

I’m back in Haiti again. It’s my fourth time back here, third since the earthquake in 2010.

I accomplished my mission of the day, which was to get my phone hooked up with a solid internet connection. That may sound like not that lofty of a goal, but A) Everything takes 20 times as long here as it does in the states, and B) This was of the utmost importance.

I got an idea for a photo essay today that would be a collection of situations that are typically Haitian in the sense that something that has a quick fix in the U.S. has been addressed in a complete roundabout, bootstrapped, jerry-rigged though effective fashion. Perhaps I’ll start a Tumblr blog. What should I call it? Haitian Situations?

On the flight in, the pilot came on the P.A. system as we were landing to tell us that he would have to circle around the island three times because there was another plane in the vicinity, so he would have to wait until it landed to begin the descent instead of descending in conjunction, “because there’s no radar.” He declared this with an air of exasperation as if to remove the responsibility of arriving two minutes behind schedule from himself and pass it off to the country of Haiti. A few passengers looked around nervously, as the expected subsequent translation took a few beats longer than usual before the flight attendant picked up the intercom device, cleared her throat, and translated to the flight that we would have to circle around because of their country’s goddamn primitive communications system, as if they needed to be reminded of the way things were where they were going by some American pilot.

As I exited the plane, I wanted to tell the pilot to please keep his First World Problems to himself here. This is what I want to tell everyone I know at some point or another. But he wouldn’t have understood, and neither would anyone else. I didn’t understand every time my mom would yell at me for running the water nonsensically or leaving the refrigerator door open while I made a sandwich. I just wondered what her goddamn problem was and proceeded to ignore her comments. Third World concerns are lost on First World citizens having never experienced the Third World, and First World complaints only seem particularly egregious if they are verbalized while in the Third World, or to a Third World dweller. Also, I’m reading J.D. Salinger right now so I want to qualify every noun with “goddamn.”

Sometimes when I explore new places, I think about scenarios I would like to see unfold. When I went to Kentucky with my roommate over Thanksgiving and we were driving around the horse farms of Lexington, I fantasized about driving a bus full of Occupy Wall Street protestors through, both to see if they would have the impulse to occupy a horse farm, and to see how the Kentuckians would go about attempting to remove them from their estate. Today, while driving around in PetionVille, a more-affluent though still not anywhere close to being considered affluent sector of Port-au-Prince, I thought about what would happen if you dropped the cast of the Real Housewives off in the middle of the street market with $5 each and said “Figure it out. Bye.”

Anyway, the progress here in Haiti appears shockingly drastic. But I’ve only had a few cursory glances, and I learned from spending some time in rural Michigan that if you make areas close to the main roads pretty, people who are just passing through will have a good impression of the whole area, meanwhile the problems can stay hidden in the back woods. But all the townspeople know.

H1N1 PSA, Haiti style

This made me really happy. In Haiti they don’t have many billboards or posters — most of the advertisements come in the form of paintings on the walls lining the main streets.

Here’s an easy to understand message on how to avoid H1N1 transmission that gets the point across regardless of literacy level. On Haiti Rewired, the community has been working together to produce a Construction Booklet with similar iconography to instruct people on the right and wrong ways to build structures that are earthquake resistant. Perhaps instead of pamphlets, we should be recruiting local artists to paint the booklet material on walls like this. That way, it’s only a matter of time before the information becomes common knowledge.