1 Joanne Davac Professor Bruce Profile Paper October 14, 2013 Cholera in Haiti Hurricane Katrina devastated the

Gulf Coast in August 2005, ruining many homes and communities, leaving many people displaced. Other than the physical destruction people can see from Hurricane Katrina, the Center for Disease Control and Prevention (CDC) reports there were twenty- two cases of Vibrio illnesses, including five deaths (2013). A person can contract cholera by consuming water and/or food that is Epidemic: affecting a disproportionately large number of individuals within a population or community at the same time Merriam Webster Dictionary contaminated with the bacterium, Vibrio cholerae (CDC, 2013). In the case of an epidemic, the source is usually the feces of an infected person

that contaminates water and/or food (CDC, 2013). Twenty- two cases seem miniscule compared to the 600,000 cases of cholera in Haiti (CDC, 2013). According to the CDC, there have been 669,396 cases and 8,217 deaths since the epidemic began in Haiti (2013). Haitis cholera outbreak is now known as the worst epidemic in recent

Figure 1: The Life Cycle of the bacterium Vibrio cholerae. Nature

history (Presutti, 2011). What exactly is cholera, and why is the illness deadly? What caused

2 this Haiti cholera outbreak, and who is to blame for this epidemic? Are there people responding? And lastly, what can we do to prevent such devastation? The origin of the Haitian cholera outbreak is yet undetermined, and the epidemic has inspired a movement of response to the vast devastation, but the most crucial issue ignited by this outbreak is the need for education regarding preventative measures. As mentioned earlier, an infection in the intestine caused by Vibrio cholerae can sometimes lead to the disease known as cholera (CDC, 2013). Most attribute the discovery of cholera to Robert Koch, who famously discovered the bacterium that causes tuberculosis; however, Filippi Pacini had isolated the bacterium that causes cholera thirty years before Koch (Department of Epidemiology, UCLA). Cholera can be an asymptomatic infection, meaning it doesnt necessarily show any symptoms. Some of those infected will experience profuse watery diarrhea, vomiting, and leg cramps (CDC, 2013). Some succumb to death from severe dehydration if they are not treated (CDC, 2013). According to the World Health Organization, about three to five million cases per year are reported, predominantly in Asia and Africa (Harris, Jason B., et al. 2012). According to my calculations, Haitis cholera outbreak in 2010 counted for about twenty- three percent of the three to five million cases of cholera that year. There are many reports on who is to blame for this Haiti Figure 2: The devastation of the earthquake in Haiti (January 2010). The Guardian cholera epidemic, but what natural

3 phenomena started it all? Laura Fitzpatrick reports in an earthquake with a 7.0 magnitude hit Haiti in January 2010. She also added that shortly after the 7.0 magnitude earthquake, there were multiple aftershocks of up to 5.9 in magnitude. This earthquake was truly devastating, taking the lives of 200,000 people and leaving millions of Haitians homeless (Fitzpatrick, 2010). The Haitian government believes that 222,570 people have died and 300, 572 have been injured (Farmer). Then in October 2010, cholera cases soared. Most would point out that Haiti is a developing country with poor sanitation; therefore, water-borne diseases are inevitable. However, a study done at Yale University blames the United Nations for bringing this epidemic to Haiti (Daniel, 2013). According to the study, as Daniel states, it holds the organization responsible for contaminating the sewage with Vibrio cholerae from a United Nations camp that was connected to one of Haitis largest rivers. Daniel continues to point out that the study links the illness to a group of United Nations peacekeepers f who came to Haiti from Nepal ten months after the earthquake. In the test, there were genetic similarities between the strains of cholera in Haiti and cholera in Nepal. (Daniel, 2013). Prior to the study done by Yale, another study showed that their data strongly suggest[ed] that the Haitian epidemic began with the introduction of a V. cholera strain into Haiti by human activity from a distant geographic source (Chin, Chen-Shan, 2011). Because of the study done by Yale, the survivors and family members of nearly 700,000 who have contracted cholera are suing the United Nations for billions of dollars, accusing the U.N. of covering up its role in starting the worst outbreak of the disease in modern history (Schecter, 2013). Schecter also mentions that the United Nations has not admitted any type of responsibility, even though medical experts including members appointed by the U.N. have agreed that they are the probable cause of the cholera outbreak.

4 No matter who is to blame for this outbreak, there are many organizations trying to alleviate the damage cholera has done. Relief organizations hope to alleviate the outbreak by providing increased health services, access to clean water, sanitation and education about the deadly disease (The American Institute of Philanthropy, 2012). One well-known organization helping Haiti in their relief efforts is the American Red Cross. Since the earthquake, this organization has helped build homes, provided access to clean water and sanitation systems as well as taught communities how to prevent the spread of the disease (American Red Cross). Another relief organization is J/P HRO. This particular organizations full-time staff in Haiti [consists of] 95 percent [] Haitian people (J/P HRO). On J/P HROs website, they state that their ultimate goal is to safely transition those people left homeless to sustainable and successful communities. J/P HROs website mentions that the earthquake and the cholera outbreak hit close to home for those volunteers and workers in the organization. Theyre trying to make a difference by giving medical assistance and by building communities for fellow Haitians in need (J/P HRO). Through raising awareness of the importance of sanitation, organizations have helped alleviate the damage that has been done. Having more than 600,000 people stricken with cholera is reason enough to find a solution to this epidemic. There have been plans to find a suitable vaccine, but not everyone is on board with the idea. Some organizations, like the World Health Figure 3: Dukoral - One of the Two Vaccinations for Cholera Pharmaceutical Technology

5 Organization and the Haitian ministry of health, believe that the vaccine would foster a false sense of security which would cause people to take a relaxed approach on sanitary measures (Cyranoski, 2011). However, according to Cyranoski, that there are other organizations, like experts in the international community, want a small project of vaccinations to be done while the Haitian government wants a larger program as soon as possible. Hopefully they can come to a definite solution to this epidemic for it can help millions of people in Haiti. Cholera not only affects those in places with poor sanitation, but it can affect us here, in America, as well. As previously mentioned, Hurricane Katrina is an example of cholera close to home. We should always be wary of the importance of prevention and control of cholera of all waterborne diseases, for that matter. According to the CDC, there are simple ways to prevent such diseases and infections; it includes drinking and using safe water, washing hands with soap and safe water, using latrines and not defecating in any body of water, cooking food fully especially seafood, and just cleaning up after yourself. The CDC also states that if water looks questionable, make sure to boil it or treat it with bleach. It may seem scary to add bleach, but it treats water to make it safe for consumption. Furthermore, the CDC believes that by adding eight drops of bleach to a gallon of water and waiting thirty minutes prior to consuming, it treats your water and keeps it safe for you to drink. By doing these simple steps, it can keep yourself and others around you safe. These preventative steps to diseases seem simple and obvious, but we dont want to be blindsided when a natural disaster can lead to outbreaks of any type of disease. It is better to be well- informed and be prepared for the worst, instead of hoping for the best. Now that it has been three years since the earthquake, we can hope and pray that Haiti is on its way to recovery from such an immense disaster.

6 Literature Cited American Institute of Philanthropy. May 2012. The Best Way to Support Relief Efforts in the Aftermath of Haitis Earthquake and Ongoing Cholera Epidemic. http://www.charitywatch.org/hottopics/Haiti.html American Red Cross. October 12 2013. Haiti Assistance Program http://www.redcross.org/what-we-do/international-services/haiti-assistance-program Center of Disease and Control. October 12 2013. Prevention and Control. http://www.cdc.gov/cholera/prevention.html --- General Information about cholera http://www.cdc.gov/cholera/general/index.html Chin, Chen-Shan. The Origin of the Haitian Cholera Outbreak Strain. The New England Journal of Medicine, 363 (2011): 33-42. Cyranoski, David. "Cholera Vaccine Plan Splits Experts: Opinion is Divided over How to Tackle the Disease in Haiti." Nature, 469.7330 (2011): 273-274. Daniel, Trenton. August 6 2013. Study: UN should be accountable for Haiti cholera. AP http://bigstory.ap.org/article/un-should-be-accountable-haiti-cholera-study Department of Epidemiology. UCLA. http://www.ph.ucla.edu/epi/snow/firstdiscoveredcholera.html Farmer, Paul. October 13 2013. Facts and figures about the 2010 earthquake in Haiti. http://www.lessonsfromhaiti.org/lessons-from-haiti/key-statistics/ Fitzpatrick, Laura. "Spotlight: Haiti Earthquake Relief." Time, 175.4 (2010): 14-27. Harris, Jason B, R. LaRocque, F. Qadri, E. Ryan, and S.Calderwood. "Cholera." The Lancet, 379.9835 (2012): 2466.

7 Presutti, Carolyn. November 16, 2011 Haitis Cholera Epidemic Not Waning; Vaccination to Begin. http://www.voanews.com/content/haitis-cholera-epidemic-notwaningvaccination-to-begin-134083213/164624.html J/P HRO. October 11 2013. http://jphro.org/about.html#sthash.zyKE2hZN.dpuf Schecter, Anna. 2013. UN caused deadly cholera in Haiti, covered it up, lawsuit says.NBCNews. http://investigations.nbcnews.com/_news/2013/10/08/20874045-un-caused-deadlycholera-in-haiti-covered-it-up-lawsuit-says?lite