River opens window to Haiti's cholera crisis

GRAND SALINE, Haiti:

RESIDENTS OF this desolate fishing hamlet use the sea as a toilet and water from the filthy river for drinking. The sea and river merge at a stagnant crossing at the edge of the village where many now worry about the deadly cholera epidemic sweeping the country.

But fear of the disease came too late for seven-year-old Feconne D'Ayiti. He died hours after drinking untreated river water, says his father, Fecky D'Ayiti.

"He began vomiting. He had diarrhoea," said D'Ayiti, 26, a fisherman.

D'Ayiti is now certain that it was cholera that killed his son.

The arrival of cholera in Haiti was not a surprise, say observers. The January 12 earthquake that left a government-estimated 300,000 dead and at least 1.5 million living in precarious tents and tarps - mostly in the shattered capital - merely shed the spotlight on long-known issues exacerbated by decades of bad governance and international band-aid solutions.

"It has always been a mystery for everyone who always wondered, 'How is it that cholera never entered Haiti?' We have all of the conditions here for it to have existed," Dr Evelyn Ancion Degraff of the World Health Organisation said Sunday during a nationwide cholera broadcast. "It's all a question about sanitary and personal hygiene."

Not entirely, say humanitarian aid workers, who argue that what Haiti needs is "a global water policy".

"Even before the earthquake, areas of the country lacked access to clean, drinkable water," said Stefano Zannini, Doctors Without Borders head of mission in Haiti. "Now the problem is worse because of the epidemic. Clean water is key to preventing cholera."

For years, people living in this seaside village and others along the Artibonite region have used the river as their main drinking source. They also use it as a bathroom and garbage dump.

"The big challenge now is to educate them that that is not possible anymore," Zannini said. "Responding to the earthquake is difficult. Responding to the cholera outbreak is difficult and related to the fact that there is no infrastructure. This makes things extremely complicated."

Anger and abandonment

Some residents in Grand Saline where the Artibonite River empties into the Gulf of Gonave feel anger and abandonment.

"We've never had an honest person here do anything for us," said Ybsen Dastino, 28, sitting underneath a tree in a dirt field. "We are left to fend for ourselves."

Grand Saline is so destitute that not even the local Catholic priest sleeps in the village. The mayor is a fugitive.

Cholera arrived here after breaking out in the Central Plateau.

Residents drink the water from the brackish river which, on a good day, resembles the colour of café-au-lait (a beverage made with milk and coffee). They bathe in it, wash in it, fish in it - and, until recently, drank from it.

"Of course, I am afraid. People are dying," Sherline Bayard, a mother of three teenagers, said as she washed in Artibonite River that epidemiologists say is spreading the waterborne infection.

"We don't have anything else," she said. "The river is all we have."

Recently, humanitarian workers installed a water filtration system, next to the shore, not far from the fishing boats that before cholera provided for a measly living. They also handed out water-purification tablets. A government campaign on cholera prevention is being heard, with children able to recite the message by heart.

But aid workers say they are a temporary fix to a much deeper problem plaguing not just rural communities like this one on northwest Haiti's coastline, but scores of others, including urban slums.

Water in Haiti has become a luxury. Only 40 per cent of the population, according to official government estimates, have access to safe drinking water either through homes or distribution points.

Water security needed

"We can treat water. But we need strong municipal water systems," said Dr Paul Farmer, founder of Partners in Health, the aid group that helped get the filtration system to Grande Saline. "What Haiti needs is water security, just like every country."

Two years ago, Farmer's humanitarian group and others issued a scathing 87-page report accusing the United States government of blocking millions of dollars in loans by the Inter-American Development Bank to provide access to safe drinking water in communities. The blockage occurred as the country was knee-deep in yet another political crisis.

In a country where a large number of children under five die of diarrhoea from drinking dirty water, the report showed the devastating consequences the lack of clean and safe water has on the population.

President René Préval has called for a coordinated and organised response to fighting the epidemic. Observers, meanwhile, say the symptoms - not the cause of the problem - are being treated.

Préval recently visited during a tour of cholera-affected communities. The executive director of the ministry of health also came. Shocked that more people had not died once he landed, Dr Gabriel Timothee later described his reaction to The Miami Herald: "Terrible. Terrible. Just 50 toilets for 30,000 people," he said.

With the only road into the town washed away by floods, and the motorised canoe ride two hours away from the nearby city of St Marc, there is now dread.

"They have forgotten that we exist. We are living like animals, pigs," said Gerald Louis, 26, sitting underneath a shed. "If this thing grabs you at eight at night, you are dead. You have no doctor, no way to get to a hospital."

Last week, the epidemic hit Haiti's quake-ravaged capital city, Port-au-Prince.

But it's not the tent cities that have Haitian health experts worried: it's the slums where, like Grande Saline, few Haitians have access to latrines and safe drinking water.

Minerva Joseph, 14, knows the dangers all too well - at least three of her friends have been lost to the disease. She now recites the government's cholera prevention message by heart, including staying out of the river to avoid hand-to-mouth infection.

"You have to bathe in the river," she said. "We don't have any other water here."

-MCT