With a subtitle like 'Cholera and Cover-Up in Post-
Earthquake Haiti' we can see that a complex and distressing
tale is about to be revealed. DEADLY RIVER focuses on the
humanitarian efforts made in the aftermath of the huge
earthquake that struck the poor nation of Haiti, which is
about the size of Maryland. Haiti is part of the Caribbean
island of Hispaniola, which it shares with Dominican
Republic. French doctor Renaud Piarroux arrived to work
there, and author Ralph R Frerichs, who had studied
cholera, started following his blogs and reports. The
result is their collaboration in this book DEADLY RIVER.
In January 2010 an earthquake of 7.0 magnitude hit Haiti
not far from the capital. Unlike Asian cities which were
regularly damaged by quakes and rebuilt stronger, Port Au
Prince was old and weak. Deaths were estimated variously at
80,000 to 230,000 and the communities were devastated.
International aid of all kinds swooped in to help in many
ways. Nine months later children started dying on the same
day as they became ill after drinking from a river,
initially thought to be caused by typhoid. Then a large
outbreak of cholera was recorded, which stopped volunteer
workers (including me) from travelling. This became a full
sized epidemic - in a country which had not before had a
single case of the ancient Asian disease cholera. Turmoil
followed both in politics and on the streets as hospitals
were overwhelmed.
Renaud Piarroux had studied diseases and worked in many
countries and actually managed to eliminate cholera from an
African island when with Medecins du Monde. The Haitian
government asked him to step in and search for the origins
of the disease. Generally it was known that cholera is
waterborne and can live in bay organisms but a harmful
strain can be transmitted through sewage and contaminated
water. Piarroux also had to find a way to protect the ten
million inhabitants from further outbreaks.
The source of the disease was found to be Nepalese troops
stationed as part of a United Nations peacekeeping effort.
The strain of cholera was found to be the same as that in a
previous outbreak in the Himalayan country Nepal. Piarroux
claims that obstacles were put in his path by UN staff, who
issued contradictory reports. Clean water and good
sanitation are an unaffordable dream for many people living
on the island, especially with patchy rebuilding efforts.
While cholera subsided during the dry season it returned
when the rain flushed contaminants into the leaking water
network. By 2015 the germs were still reappearing and had
infected about one in twenty Haitians, mostly the poor and
vulnerable.
Emerging diseases such as Ebola and Zika are on our news
screens with sad regularity so I felt that advances should
be made, and lessons learned, from the work of tracing and
conquering cholera. Only by sending in experienced staff to
work on the ground can this be done. I have also read
about 'disaster capitalism' in Haiti and other lands; this
shows how money can be made from soaking up aid funds to
supply goods, services and trained people when and where
needed. When something goes wrong, the rich and powerful do
not want to be blamed or made to pay compensation.
DEADLY RIVER is a sobering story of epidemiology and
scientific detective work. This will intrigue anyone
working in or studying the medical field, as well as city
planners, aid workers, charity supporters and travellers,
and those interested in geopolitics. Journalists will be
interested in the fact that the Nepalese connection was
first made publicly by Jonathan Katz in an online version
of 'La Presse', a Canadian newspaper, while Sebastian
Walker televised a report containing quite the opposite of
UN statements, documenting poor sanitary conditions around
the Nepalese camp. Deborah Pasmantier also put the pieces
together and published widely on the net. Their
investigative journalism is reproduced for us.
We can also see just how poor this island's population is
while raising enough rice to sustain itself. Indeed the
rice paddies were a major factor in the spread, making
DEADLY RIVER quite a different story to a book I had read
on cholera in London. No NGO (non government organisation)
could resolve the problem without working with the local
government and infrastructure providers. The history of
cholera which may have been with humans for ten thousand
years in South Asia is also well drawn. Ralph R. Frerichs
and Renaud Piarroux have provided us a tragic tale to
remember and food for thought. You won't want to read this
while eating, and you will certainly remember to wash your
hands before making a sandwich.
In October 2010, nine months after the massive earthquake
that devastated Haiti, a second disaster began to
unfold—soon to become the world's largest cholera epidemic
in modern times. In a country that had never before reported
cholera, the epidemic mysteriously and simultaneously
appeared in river communities of central Haiti, eventually
triggering nearly 800,000 cases and 9,000 deaths. What had
caused the first cases of cholera in Haiti in recorded
history? Who or what was the deadly agent of origin? Why did
it explode in the agricultural-rich delta of the Artibonite
River? When answers were few, rumors spread, causing social
and political consequences of their own. Wanting insight,
the Haitian government and French embassy requested
epidemiological assistance from France. A few weeks into the
epidemic, physician and infectious disease specialist Renaud
Piarroux arrived in Haiti.
In Deadly River,
Ralph R. Frerichs tells the story of the epidemic—of a
French disease detective determined to trace its origins so
that he could help contain the spread and possibly eliminate
the disease—and the political intrigue that has made that
effort so difficult. The story involves political
maneuvering by powerful organizations such as the United
Nations and its peacekeeping troops in Haiti, as well as by
the World Health Organization and the U.S. Centers for
Disease Control. Frerichs explores a quest for scientific
truth and dissects a scientific disagreement involving
world-renowned cholera experts who find themselves embroiled
in intellectual and political turmoil in a poverty-stricken
country.
Frerichs’s narrative highlights how the
world’s wealthy nations, nongovernmental agencies, and
international institutions respond when their interests
clash with the needs of the world’s most vulnerable people.
The story poses big social questions and offers insights not
only on how to eliminate cholera in Haiti but also how
nations, NGOs, and international organizations such as the
UN and CDC deal with catastrophic infectious disease epidemics.
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