On 12th January, 2010 Haiti experienced a new drama. An earthquake seven points of moment magnitude shocked the country leaving after it a trail of devastation and worst of all a stealth battle of ruthless numbers.

At the beginning of 2011, one year after the disaster, the Haitian government increased the initial death toll from 220.000 over 300.000 while the international community set a number lower than 100.000. They did it unexpectedly, without any previous comment and not defining the parameters and methodology used for the estimation.

Maybe they thought two hundred were not enough to boost international aid, and a bigger new headline of misery would have helped them to raise more funds. The math is obvious for Haitian rulers: higher victims mean more pity and shame which tends to increase international aid flowing into the country.

According to Inter-American Development Bank the earthquake caused damage estimated near 14 billion dollar, more than the country GDP, and somehow they need to put pressure on international donors both to increase the amount pledged, 5.3 billion dollars, and to speed the deliver into the country up.

It is believe that Haitian government had added into earthquake victims, among other, the subsequent 200.000 cholera infected and 4.000 dead. A rate that is still growing as of March 2011 rises to 300.000 with 5.000 deaths reported by WHO.The first cholera case appear months after the earthquake, it was reported on 14 October 2010 in the department of Artibonite, the country largest department located in the north-west side of the island, from where the disease quickly spread through Artibonite Rive affecting other departments.

Cholera is an infection of the intestine caused by a bacterium that causes diarrhea and vomiting which in severe cases can lead to death by dehydration due to an untreated patient may produce 10 liters of diarrheal fluid a day. The last cholera epidemic in Latin America started Peru in 1991, during the 7^th pandemic and after reach other countries but not Haiti, a country with none recorded cases previous 2010.

The earthquake caused massive population movements inside the country as in Cité l’Eternel, a neighborhood in Port-Au-Prince, home for tens of thousands of families who live crammed together in tiny shacks with no running water or proper sewage facilities. The mounds of garbage and the open sewers full of human waste are breeding grounds for cholera, typically transmitted by either contaminated food or water.

After a rapid spread the worst part took place between mid November and January, usually with more than 10.000 cases per week throughout the country, uncontrollable sometimes like the first week of the year when 14.000 cases just in Port-Au-Prince were reported.

While all this misery happens in Haiti, in the neighboring Dominican Republic were just 200 reported cases during the whole year, confirmed along the borderline, a gap which can be explained by their citizens’ wealth.  The GDP per capita is eight time higher in Dominican Republic than in Haiti, where just 96 dollars per year an person can be spent in health care.

Thus creating a risk profile for cholera within a population where 60 percent suffer from prevalence of undernourishment, 40 percent has no access to improved drinking water and just 20 percent has access to improved sanitation before the earthquake. The World Health Organization states also that cholera is one of the key indicators for social development.

While the disease no longer poses a threat to countries with minimum standards of hygiene, it remains a challenge to countries where access to safe drinking water and adequate sanitation cannot be guaranteed. Almost every developing country faces cholera outbreaks or the threat of a cholera epidemic. As it can be imagined Africa nations head the rank.

With this outlook after the earthquake just NGOs were able to contain the epidemic, but it should be emphasized that dying by cholera is not easy with a minimum sanitation care. Around 75 percent  people infected do not become ill, but when illness does occur, 80 to 90 percent of episodes are of mild or moderate severity which can be treated with a simple treatment of oral hydration solutions, mere sugar and salt mix to be ingested costing about 10 cents the sachet.

For severe dehydration cases intravenous rehydration is necessary with mortality rate lower than 1 percent but untreated it raises over 50 percent. Moreover currently in the market two preventive vaccines are available; Dukoral and Sanchol, both with a protection close to 8o percent for the first two years and a cost between 1.50 to 5 dollars a dose.

Still, the cruel reality is that there is no money for everything and priorities have to be done. That is why some experts argue that a vaccination campaign would be neither feasible nor cost-effective, and advocating putting forth other measures. According to UNICEF NGOs have been deploying several initiatives to prevent, contain and reduce the epidemic.

In partnership with the Ministry of Health they are working to raise awareness about cholera through radio, television and text messages targeting at least 80 per cent of the population.

Through neighborhoods they have been putting up posters to help teach people how to protect themselves and giving information about the disease in schools, health centers, market and even door to door, with an aim to ensure that households have at least one person who knows how to prevent cholera and what to do in case symptoms occur.

Furthermore they install public water points where water tankers provide free and pure potable water where water purification tablets and soap are free handing out too. Without this facilities cholera spreading would have been unstoppable because in water kiosk 5 gallons of drinkable water cost up to one dollar when most of the population is surviving with less than a dollar per day, so is unaffordable for almost everybody.

A complete sanitation and potable water system for 1000 people during a year costs 18.000 dollars or more, so many times is too expensive as well. That is why they seek for other sustainable alternatives like wells, another effective and cheap way to allow easy access to safe water. After the well is constructed the NGOs put in charge a different committee for each site to makes sure it keeps running effectively.

Owing to the lack of resources NGOs try to do their best in a very difficult situation. Now that media focus has been diverted to the nuclear crisis Japan and Somalia famine the donatives have been critically reduced and foreign aid tends to displace to hot points. Under these circumstances nobody can be sock by the macabre game played by Haitian government.

Headlines are more important now than ever to keep the attention over a country where still 600.000 people live in displacement camps and 40.000 new cholera cases per month. Unfortunately more people are dying by starvation in Africa and like in a Machiavellian chain this triggers off mass media interest; giving television, radio and press space.

The chain continues with international donors, as foundations or governments seeking for recognition or NGOs seeking for promotion, increasing their efforts in the hot spot and therefore reducing staff and money from other projects. Likely the organizations in Haiti will be able to steadily reduce the monthly cholera cases and deaths into a situation under control, but not capable of eradicating it.

The country is struggling right now against a new endemic disease, they can win or they can lose and resign themselves to counting dozens of deaths per month. Everything depends on international help, Haiti is totally crippled, but these days developed countries are bailing banks out with tons of dollars used to make up a financial balance instead constructing a well for potable water that actually could save lives.

Image Courtesy of  http://www.flickr.com/photos/britishredcross/

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