Wednesday, December 29, 2010

Tuesday, December 28, 2010

Fidel on Haiti

Photo by John Carroll
December, 2010

Fidel hints at parallel between Haiti, Cuba
Tacit message: Solutions won't come from abroad

In his latest "reflection," Fidel Castro appears to draw a parallel between Haiti and Cuba, hinting at the catastrophic effects of forcing a nation to globalize when it's simply not ready.

To do so, Castro takes on the voice of Brazilian diplomat Ricardo Seitenfus, who last year was appointed special representative of the Organization of American States in Haiti. Seitenfus was abruptly removed from his post last week, on Dec. 25, presumably for statements he made Dec. 20 to the Swiss newspaper Le Temps.

In his article, published Tuesday in Granma, Castro uses one of his preferred literary techniques: to select excerpts from other people's writings to make his own point. Here are some of the Seitenfus quotations he chose.

"Force is what defines international relations with Haiti, never dialogue. Haiti's original sin on the world scene is its liberation. The Haitians committed the unacceptable in 1804: a crime of lèse majesté for an impatient world. [...] The Haitian revolutionary model scared the big powers. The United States did not recognize Haiti's independence until 1865. [...] From the start, independence was compromised and the country's development blocked. [...]

"They want to turn Haiti into a capitalist country, a platform of exportation for the American market. That's absurd. [...] One part

of Haiti is modern, urban and looks abroad. [...] It is a country open to the world. [...] More than 90 percent of the educational and health systems are in private hands. The country has no public resources to operate a state-run system, even minimally.
"The problem is socioeconomic. When the rate of unemployment reaches 80 percent, to send a stabilization mission is unsustainable. There is nothing to stabilize." [Blogger's Note: The reference is to the United Nations' Stabilization Mission to Haiti, which has been there since 2004.]

"Haiti is not an international threat. We are not in a civil war situation. [...] For the U.N., the purpose was to freeze power and transform the Haitians into prisoners on their own island.

"Emergency aid [from abroad] is effective, but when it becomes structural, when it replaces the state in all its tasks it becomes a collective lack of responsibility.

"For the transnational NGOs, Haiti has become in a place of forced passage [...] of professional formation. [...] There is an evil or perverse relationship between the strength of the NGOs and the weakness of the Haitian state. Some NGOs exist only due to the Haitian misfortune.

"Faced with the massive importation of consumer goods to feed the homeless people, the situation of Haitian agriculture has worsened. The country offers free room to all humanitarian experiences. It is morally unacceptable to consider Haiti as a laboratory. Haiti's reconstruction and our promise of $11 billion [in aid] stoke greed.

"[Haiti] is the sum total of our dramas and the failures of international solidarity. We're not up to the challenge. [...] It is necessary to go to the Haitian culture, it is necessary to go to the land. [...] Nobody takes the time or wishes to try to understand what I would call the Haitian soul."

December 28, 2010 in Economy & Trade, Fidel Castro, The Americas | Permalink

Read more:

Failing Haiti

Photo by John Carroll
Southern Haiti

From: Isabeau Doucet
Haiti: where aid failed

Why have at least 2,500 people died of cholera when there are about 12,000
NGOs in the country?

Haiti should be an unlikely backdrop
for the latest failure of the humanitarian relief system. The country is
small and accessible and, following last January's earthquake, it hosts one
of the largest and best-funded international
aiddeployments in
the world. An estimated 12,000 non-governmental organisations
are there. Why then, have at least 2,500 people died of
a disease that's easily treated and controlled?

I recently went to Haiti's capital, Port-au-Prince, and found my Médecins
Sans Frontières (MSF) colleagues overwhelmed, having
already treated more than 75,000 cholera cases. We and a brigade of Cuban
doctors were doing our best to treat hundreds of patients every day, but few
other agencies seemed to be implementing critical cholera control measures,
such as chlorinated water distribution and waste management. In the 11
months since the quake, little has been done to improve sanitation across
the country, allowing cholera to spread at a dizzying pace.

Ten days after the outbreak hit Port-au-Prince, our teams realised the
inhabitants of Cité Soleil
still had no access to
chlorinated drinking water, even though aid agencies
under the UN water-and-sanitation cluster had accepted funds to ensure such
access. We began chlorinating the water ourselves. There is still just one
operational waste management site in Port-au-Prince, a city of three million

On the one hand, Haitians were deluged with text messages imploring them to
wash before eating, while on the other they had to bathe their children in
largely untreated sewer water. Before the quake, only 12% of Haiti's 9.8m
people received treated tap water, according to the US Centres for Disease
Control (CDC).

The road to controlling a cholera epidemic has been paved by hundreds of
previous outbreaks worldwide. Yet, in Haiti, there are vast gaps in the
deployment of well-established control measures. Now the epidemic is
nationwide, making more than 120,000 people sick and killing at least 2,500.

In the face of this ferocious outbreak, investigations into its origin have
not been released publicly, even though this information is fundamental to
understanding the epidemic's behaviour.

Hypotheses of cholera's origin range from the contamination of the river
Artibonite by UN peacekeepers, through climate change to voodoo. In the
absence of transparency, fear and suspicion have provoked violence. The
population's anxiety is only amplified by catastrophic epidemic projections
by the Pan American Health Organisation (PAHO), a sister of the World Health

PAHO's epidemic modelling has not led to effective aid deployment. Huge
amounts of aid are concentrated in Port-au-Prince, while scant support has
been provided to inexperienced health workers in rural areas, where cholera
is flourishing. MSF teams have found health centres with shortages of
life-saving oral rehydration solution, and clinics that were simply shut.

It is against this backdrop that many non-governmental agencies have
launched fundraising appeals, even while their post-earthquake coffers
remain filled. The UN's Office for the Co-ordination of Humanitarian
Affairs(OCHA) has repeatedly claimed that
underfunding of its $174m cholera appeal,
launched primarily to benefit private groups, is hampering the response –
despite the fact that Haiti is the top-funded UN appeal for 2010. As nearly
a million Haitians remain homeless in the face of a full-blown public health
emergency, arguments that existing funds are tied up in longer-term
programmes ring hollow.

The inadequate cholera response in Haiti – coming on the heels of the slow
and highly politicised flood relief effort in Pakistan – makes for a damning
indictment of an international aid system whose architecture has been
carefully shaped over the past 15 years.

Throughout the 1990s, the UN developed a significant institutional apparatus
to provide humanitarian aid through the creation of the Department for
Humanitarian Affairs in 1992, later renamed OCHA, all the while creating an
illusion of a centralised, efficient aid system. In 2005, after the Asian
tsunami, the system received another facelift with the creation of a rapid
emergency funding mechanism (CERF), and the "cluster" system was developed
to improve aid efforts.

The aid landscape today is filled with cluster systems for areas such as
health, shelter, and water and sanitation, which unrealistically try to
bring aid organisations – large and small, and with varying capacities –
under a single banner. Since the earthquake, the UN health cluster alone has
had 420 participating organisations in Haiti.

Instead of providing the technical support that many NGOs could benefit
from, these clusters, at best, seem capable of only passing basic
information and delivering few concrete results during a fast-moving
emergency. Underscoring the current system's dysfunction, I witnessed the
Haitian president, René Préval, personally chairing a health cluster meeting
in a last-ditch effort to jump-start the cholera response.

Co-ordination of aid organisations may sound good to government donors
seeking political influence. In Haiti, though, the system is legitimising
NGOs that claim responsibility for health, sanitation or other areas in a
specific zone, but then do not have the capacity or know-how to carry out
the necessary work. As a result, people's needs go unmet.

While co-ordination is important, it should not be an end in itself. It must
be based on reality and oriented towards action to ensure that needs are

In Haiti, the cholera outbreak will continue to claim lives for the
foreseeable future. What is clear, though, is that the aid community at
large has failed to prevent unnecessary deaths, in a population already so
tragically affected by one catastrophe after another.

Wednesday, December 22, 2010

What is the Solution for Haitian Elections?

Photo by John Carroll
December, 2010

Posted on Mon, Dec. 20, 2010

Solution for Haiti's election? Depends on who's talking


In a traumatized nation with a poor history of clean voting, Haiti's recent elections were a disaster waiting to happen.
There was -- and is -- pervasive lack of confidence in the eight members of the electoral council because some perceive them as being hand-picked by President René Préval.

Allegations of massive fraud were rampant even before polling stations opened for the Nov. 28 presidential and legislative elections, whose final results are yet to be released.

And the international community, which paid most of the $29 million tab for the elections, vacillated between paternalistic bullying of Haitian officials and a hands-off partnership.

Now that same international community -- unsure over what should come next as Haiti's electoral commission delays the final vote count while technical experts from the United States and elsewhere sift through tally sheets -- is faced with how to get Haiti back on track.

What everyone wants to avoid is a downward spiral into chaos that will hamper future efforts to help the quake-battered nation recover.

The way forward is not clear, and there are no easy choices. They range from an outright annulment of the vote with an interim government charged with organizing new elections -- in perhaps two years -- to a power-sharing agreement.

Among the ideas that have been suggested:

• Cancellation of this round of elections and Préval's early departure. So far opposed by the international community, this idea was put forth by 12 presidential candidates in a letter-writing campaign with Canadian and U.S. lawmakers launched last week.

• A second round with the presumed top three vote-getters: Former first lady and academic Mirlande Manigat, former government agency head and Préval pick Jude Célestin and musician Michel ``Sweet Micky'' Martelly, whose backers set the streets ablaze after the council said he had been edged out of a runoff spot by Célestin.

Brazil has pushed for this alternative. Questions have been raised about the constitutionality of such a move. Manigat opposes it.

• A new winner-take-all election with all 17 presidential candidates taking part and appointment of a new electoral council. Martelly put forth this idea. Some say it has little chance of winning favor.

• A runoff with Martelly and Manigat, courtesy of Célestin, who would voluntarily withdraw. There would also be a runoff for legislative seats with the likely outcome of Préval's INITE (UNITY) coalition controlling a majority in parliament.

• A second round with Manigat and Célestin, after which the winner would face questions of legitimacy.

• Formation of a coalition government with the opposition.

``We now have an electoral challenge that is acute,'' U.S. Secretary of State Hillary Clinton said last week during a visit to Canada. ``The electoral challenge, the instability in the government, the lack of a clear way forward as to who will be assuming leadership responsibilities, requires the international community to act and provide technical assistance, provide support for unraveling the complexities and questions surrounding the election.''

The story of how Haiti and its foreign friends reached this dangerous impasse is a tale of good intentions by outsiders clashing with the harsh realities of a nation with weak institutions, a shattered government and a history of electoral fraud.

``We've had elections since 1987, and with the exception of 1990, all of them quite bad. I don't think we've made much progress,'' said Robert Fatton, a Haiti expert at the University of Virginia.

Even before the November vote, many Haitians doubted whether their country could pull off acceptable elections.

While a gentleman's agreement to postpone the vote might have worked in some other countries, it couldn't in a nation with a history of dictatorship and distrust.

A national survey of 1,275 Haitians taken on behalf of the United States Agency for International Development revealed that while an increasing number of Haitians planned to vote, respondents were equally split on whether the elections would be fair or not.

In fact, the survey showed that 39 percent of respondents interviewed between Aug. 18 and Sept. 2 believed the electoral council was corrupt. Overall confidence in the council had fallen to 56 percent in June of 2010 from a high of 78 percent the previous June.

Weeks before the vote, Colin Granderson, head of the joint Organization of American States-Caribbean Community observer mission, remarked that the main obstacle to good elections had nothing to do with the technical expertise or know-how of the council.

It had to do with ``the total lack of trust in the impartiality of the [council].''

Préval told The Miami Herald earlier this year that twice he had changed the council on the recommendation of various groups and opposition leaders. Each time, he said, the opposition complained about the new appointees.

Haiti watchers say Préval should have recognized that it was in his own interest and that of the country's to completely replace the council.

Others criticize the international community, especially the United States, for wavering on how to handle the election. The United States, for example, went from wanting to stack the council with technical experts to changing its mind days later, without explanation. Adding to the challenge: The entire United Nations electoral brain trust died in the cataclysmic earthquake.

Failure to change the electoral council, said Mark Schneider of the International Crisis Group, a Washington think tank, ``simply fed the view that the electoral process was never going to produce a fair result.''

``Now what may be the only way to get any agreed-upon next step is for a high level internationally respected panel to review or carry out a verification process and make recommendations for a way forward,'' Schneider said.

Yvon Neptune, one of the few presidential candidates not calling for a cancellation of the vote, said the provisional electoral council is not solely to blame for the mess.

``What we are seeing now in the electoral process is a reflection of Haitian society. You take all of the sectors that are involved in the electoral process, directly or indirectly, and there is a question of credibility,'' he said. ``We are a product of our history. It has been a history of turmoil. It has been a history of corruption.''

Since doing away with dictatorship 24 years ago, Haiti has struggled to build democracy and institutions up against inequities in wealth distribution, a lack of rule of law, overthrown governments -- and now a feeling of despair after the January earthquake.

A deadly cholera outbreak and largely invisible reconstruction effort have contributed to the general atmosphere of gloom and disappointment.

Meanwhile, the international community has wavered between wanting to allow Haitians to chart their own course and getting more involved in the details.

``However unpopular Préval may be, he represents continuity, which is the single most important thing the international community values,'' Fatton said. ``In other words bad elections will be tolerated in the name of continuity. The problem though is that continuity is not necessarily what Haitians want.''

Some argue that a political agreement is needed now -- not later.

With opposition to Préval far from monolithic, he remains the key actor in Haitian politics.

Still, some in the international community have given up on the man once viewed as Haiti's ``indispensable'' politician. ``Eighty percent of the Haitians voted against him,'' said one foreign diplomat, since his candidate, Célestin, got only 22 percent of the vote.

That reality along with the accusations of fraud by INITE, and the fear of violence in the coming days, has diplomats wondering about what will become of Préval. Will he, like most of his predecessors, exit into exile -- or will he become Haiti's elder statesman?

Eduardo Gamarra, a Florida International University professor and political analyst, said the most important thing over the longer term will be getting a credible government in place.

``But that credible government will have to come from among the three [top vote-getters]. The question is who among them is best able to help Haiti on that path -- a singer with no real record of administrating, a former first lady who is dignified but has no real record or a man who has run a government construction company with extraordinary ties to the old Haitian establishment and all that means?''

Tuesday, December 14, 2010

Listening to Haiti, by Danny Muller

Great article by Danny Muller in Counterpunch.

Please read it.

Incredible Widnerlande

Widnerlande has her appointment with the US Consulate in Port-au-Prince at 7 AM Thursday morning (two days from now)!!

This appointment will determine whether this seven year old little girl is granted a non immigrant visa to fly to the United States on Friday for her heart surgery. Widnerlande's surgery is scheduled for December 23 in California.

Please go to this post by Maria detailing Widnerlande's six year wait for surgery.

The Poor Always Pay, by Beverly Bell

Photo by John Carroll



By Beverly Bell

December 13, 2010

The start of Haiti’s most recent crisis came with ample warning. Most
Port-au-Prince residents scurried to their homes mid-afternoon last Tuesday,
certain of the violence and chaos which would ensue once the electoral
council announced which two presidential candidates would make it to the
run-offs. The trouble-makers didn’t wait until the 8:00 p.m. announcement,
but started throwing rocks and erecting barricades by late afternoon for
good measure. By nightfall, gunfire ricocheted around the capital and other
towns. Through Friday, the black smoke of burning-tire barricades rose above
the small crowds who rampaged through towns, destroying shops and other
structures, burning cars, and occasionally shooting people. Haitian Radio
Metropole reported five deaths.

The electoral council’s results were as transparently
the vote
The only candidate with popular appeal, Michel Martelly, was excluded from
the run-off. The widely hated president René Préval’s chosen successor, Jude
Célestin, was inserted into the January 16 run-off along with Mirlande

Scrambling to get itself out of its jam, the electoral council announced a
recount, but both Martelly and Manigat have rejected this option.
Cancellation of the vote is a distant option. The council’s routes through
which to backpedal appear blocked.

Meanwhile, on Friday, Sen. Patrick Leahy, who sits on the Senate
Appropriations Committee,
President Obama to withhold aid to the Haitian government and suspend
travel visas of senior Haitian officials until “necessary steps” are taken
to guarantee a democratic result. And yesterday, the United Nations,
Organization of American States, European Union, American, and four other
ambassadors in Haiti
urged the
government on to the next legal step, requesting that the 72-hour period in
which parties may contest the results begin today.

The weekend brought calm - partial on Saturday and broader on Saturday. Some
ventured out hesitantly after days spent house-bound to stock up on food or
view the destruction, but still motor vehicles and pedestrians remained
scarce. This morning dawned as just another Haitian day, except that schools
remain officially closed. But there are more electoral council announcements
on the horizon. No one knows what the coming week will bring, but calm is
not high on the list of options.

The only ones who stand to gain from the current upheaval are the candidates
vying for victory, and the demonstrators and agitators they have paid. Some
acts of violence and construction of road barricades appeared to be random,
enacted by thugs who control various neighborhoods or others who were
perhaps simply bored. Those grassroots organizations who normally sponsor
demonstrations against Préval sat this week out; these are not the
activities of an organized pro-democracy movement.

As always, it is the poor who have paid the heaviest cost. For starters,
those who live from the informal economy have lost days of the miniscule
incomes which barely keep their families alive. The small army of vendors of
phone cards who congregate at gas stations, the men who peddle long-expired
medications from red buckets on their heads, the women who sell imported
corn flakes or second-hand underwear, and all the rest were not to be found
on the deserted streets from Wednesday through the weekend, meaning that
their families lost the few cents they make on each sale.

Those living in shantytowns where much of the violence was concentrated
could not leave their homes out of fear. Neither could those living under
plastic tarps or tents on the streets or in internally displaced peoples’
camps in volatile neighborhoods; they, moreover, could not even retreat
behind walls or lock their door. Numerous women in these settings, among a
circle who call me whenever they can buy cell phone minutes, reported that
their meager supplies of food and water ran out after a day or two. With no
means to buy more even if they could have gone to the market, they ran to
neighbors’ homes in calmer moments to try to collect small gifts to sustain
their children – sometimes with more success than others. Hunger, every
woman told me, has been the norm since Wednesday.

Yesterday morning, for example, one of my daily calls was from Dieuveut
Mondestin. She is a widow who lives with four children and an infant in a
tarp-covered lean-to in the shantytown of Martissant. She has no nearby
relatives, no job or other source of support, no source of free or nearby
water, and no electricity. Dieuveut had just returned from two days in the
hospital, where she was watching over her dead husband’s father who had
cholera. I ask how she’s made out these last few days. “I can’t suffer
anything I haven’t already suffered, so I still have hope. But it’s been
hard, hard, hard, I tell you. There was so much shooting in my neighborhood,
there was nowhere to run. I haven’t had anything to feed my kids. They’re so
skinny, even little Larissa; you remember she was chubby. They’re just
sticks now.”

This past week has also provided the perfect conditions for a spike in
cholera, what Partners in Health calls “a disease of
” which impacts those without safe drinking water. With roads blocked and
all but a valiant few health care and sanitation workers at home, much of
the humanitarian coordination effort in Port-au-Prince and other parts of
Haiti was in “lock-down,” a high-level cholera response worker told me on
Friday. My inbox brought an urgent call for anyone who could travel to ten
camps to deliver the cholera-prevention essentials of water purification
tablets and bleach. Clean drinking water, another essential, also ran out in
many places early on in the days of mêlée.

Because sanitation workers could not get to the camps, toilets and garbage
overflowed to extremes. (For a chilling account, see Sascha Kramer's recent
article in Counter Punch
.) The
sporadic rains throughout the week, moreover, spread contaminated water and
sewage, perfect vectors for the disease.

One eye-witness told me that the group controlling the burning tires on the
central Champs de Mars Boulevard refused to let medical transport vehicles
through. The street barricades and lack of available drivers limited
possibilities of the cholera-struck to get to health care centers during the
window in which healing is possible, which in extreme cases is as short as
four hours. Lack of drivers for medical vehicles also meant that corpses of
many cholera victims remained in camps, bringing serious risk of

The socially and economically marginalized will gain nothing for their
troubles, as no president sympathetic to their cause is forthcoming from
these elections. None of the 19 candidates has been outspoken or active on
behalf of the needs of survivors languishing in camps, or on behalf of a
reconstruction process or economic model which prioritizes the most
vulnerable. The unknown Célestin, from the party that has failed the
citizenry, is so clueless about state responsibility that he even told a
campaign crowd, “To counteract this illness [cholera] is a matter of hygiene
more than anything. Hygienic measures, the state can’t assume that… It’s a
personal and individual matter.” [1] The right-wing intellectual Mirlande
Manigat briefly served as first lady in 1988 to the figurehead civilian
president of a military dictatorship, but is otherwise undistinguished.
Michel Martelly has made public no policy agenda, though it’s hard to
imagine that he could effectively push through any policies. His notoriety
stems being a buffoon and carrousing musician, known for such
non-presidential antics as flashing his bare backside in public.

A vote for Martelly, several people interviewed for this article said, was a
vote against the standard political elite. Human rights lawyer Patrice
Florvilus said, “The [people] don’t know if Martelly will give them anything
different, but they know that they won’t gain anything from the suits who
are the current politicians. Martelly is a product of the vacuum of
alternatives. People need an alternative to the current conditions of their
life but they’ve been totally abandoned.

“So many have been under tents for eleven months with nothing coming to
them. They haven’t seen any of the international aid. They’re at the end of
their rope with their social problems. It’s such a shame that politicians
are using them for their own political profit.”

Regardless of who wins and how, the next president will come in with
constitutionally constrained powers. Since the parliament ceded its power in
April to the Interim Commission for the Reconstruction of Haiti, a 28-member
body whose membership is 50% foreign and whose co-chair is Bill Clinton, the
president holds little power over the country’s future beyond the right to
veto the commission’s decision. With the World Bank as the group’s fiscal
sponsor and all the international muscle around the table, even that veto
option is unlikely to translate to much authority. This constraint will
remain at least until the commission’s current mandate expires in August

The electoral debacle appears to have one other beneficiary besides whoever
wins the presidency. It is the boys who, for once in this super-dense city
with almost no recreational spaces, have had endless open streets on which
to play soccer. Block after block is full of fleet-footed kids moving
between the broken cinder blocks which serve as goals. On an outing to check
out the state of the streets, I called out to one group of boys, “The
elections gave you your soccer field. You lucked out!”

One called back, “No way! We’d rather have a free election!”

Many thanks to Allyn Gaestel for her research help.

*Beverly Bell has worked with Haitian social movements for over 30 years.
She is also author of the book Walking on Fire: Haitian Women's Stories of
Survival and Resistance. She coordinates Other Worlds,, which promotes social and economic
alternatives. She is also associate fellow of the Institute for Policy
[1] Campaign speech of Jude Célestin, Port-au-Prince, November 25, 2010,
taped by Reuters journalist Allyn Gaestel.

Rachel Wallis
Other Worlds
Media and Education Coordinator

Monday, December 13, 2010

Cholera Claims Young Victim

Photo by John Carroll

Five days ago a 19 year old girl was admitted to our Cholera Treatment Center (CTC) with symptoms of severe cholera. She had been in another hospital but had been discharged and sent to our CTC.

I will call her Magda.

Magda had all the obvious signs and symptoms of cholera. She had severe vomiting and diarrhea, her eyes were sunk, she was barely responsive, and I could feel no pulses in her cold arms.

Her mother came with her and said that Magda was pregnant but everyone was unsure how far along and Magda was not able to help with history.

Magda received IV fluids full bore for the next few days, woke up, and she looked some better. But she was very weak as most people are who survive severe cholera.

Yesterday, on Sunday, when I was making rounds in her hot tent, Magda cried out complaining of severe pain in her pelvis. Shortly after, while lying on her cot, she screamed again, and a grey sack appeared at her birth canal. The sack, which was her gestational sack, burst open with the egress of blood and water.

Magda was obviously having a miscarriage.

As I assessed this situation, I saw that her IV catheter was no longer in the back of her hand but was lying wrapped in tape on the floor of the tent.

So I hustled out to the main supply area and got another IV catheter and a liter of fluid. When I got back, Magda was sitting on her cholera bucket in no apparent distress.

I bent down and was able to look between the upper rim of the bucket and her hips and saw a perfectly formed baby hanging straight down from the birth canal. I could only think of one thing with this horrible scene...a black lynching in the South.

The baby was a tiny little girl a little bit longer than the length of my hand.
Her mouth was gaped open and her eyes were also open and staring at the sides of her mother's cholera bucket. The baby's umbilical cord curved back up and ran back into the birth canal.

So I started an IV into the back of the Magda's right hand as she sat on the bucket with her head down, and I opened up the infusion full bore. We then transferred Magda back to her cot.

Magda's pain had diminished significantly and she seemed stable. I placed the aborted baby between her legs.

After half hour had passed, we were able to deliver the small placenta. The placenta and umbilical cord were dropped through the hole in the cholera cot, I quickly baptized the baby, and let it slip through the hole in the cot.

As the baby fell into the bucket with a thud, I asked myself if I realized that I just dropped a dead little human being into a filthy cholera bucket in a sweltering hot tent. I realized it but didn’t think this could hardly be happening in 2010.

The unborn little baby girl had her chance for about five months, safe in Magda's womb, until cholera killed her.

Magda's father showed up and watched all this from an adjacent cot. He was drunk on clarin and crying.

So I continued the fluids and added 20 units of Pitocin to stop the bleeding in the uterus.

Magda's blood pressure was a remarkable 136/80 and she seemed fine for all she had just been through. Nineteen year olds can withstand a lot.

The nurses removed the baby from the cholera bucket and wrapped it in a plastic baggy and gave it to Magda's mother to bury somewhere.

Will this baby be counted in the 2000 plus deaths that cholera has claimed in Haiti in less than two months? Probably not.

But she sure looked human to me.

Sunday, December 12, 2010

Saturday, December 11, 2010

The Cholera in Haiti is not the Same Cholera in the rest of Latin America

The V. cholerae strain responsible for the expanding cholera epidemic in Haiti is nearly identical to so-called variant seventh-pandemic El Tor O1 strains that are predominant in South Asia, including Bangladesh.23,24 The shared ancestry of the Haitian epidemic strain and recent South Asian strains of V. cholerae is distinct from that of circulating Latin American and East African strains of V. cholerae. Patterns of DNA from Haitian strains and V. cholerae strains in a large collection held by the CDC, as determined by means of pulsed-field gel electrophoresis, also suggested that the Haitian strains of V. cholerae are most similar to recent South Asian V. cholerae strains.3 Our comparative analysis of the H1 and H2 strains and three CDC isolates indicate that the Haitian cholera epidemic is clonal. Collectively, our data strongly suggest that the Haitian epidemic began with introduction of a V. cholerae strain into Haiti by human activity from a distant geographic source.

New England Journal of Medicine
December 9, 2010

Senator Patrick Leahy Urges US to Decrease Support of Haitian Government

This action by Senator Leahy may help. Please read this.

Friday, December 10, 2010

John Carroll's Five Stages of Cholera

John Carroll’s Five Stages of Cholera...That You Won't Find in The New England Journal of Medicine

Stage V:
This is the worst stage. Patient appears cold and lifeless. His eyes are neither fully open nor completely closed. When an IV is started he doesn’t budge.

The doctor’s sphincter tightens and he is very, very distressed.

Stage IV:
Patient has palpable carotid pulse but no brachial or radial pulse. Patient barely responds to any stimuli.

The doctor is very distressed.

Stage III:
Patient has brachial pulse, but no radial pulse. Patient will look at doctor and respond appropriately at times.

The doctor is kind of distressed.

Stage II:
Patient has both radial and brachial pulses and has warmed up some. Patient conversant most of the time.

The doctor is happy.

Stage I---Patient has all pulses back and sits on edge of cot. And when asked how he is the patient replies, “ I am weak and my stomach hurts”.

The doctor is ecstatic with happiness.

Cholera Vaccine

See this NPR article.

Great Article by Sasha Kramer

Read it here.

Good Morning! December 10, 2010

Good morning everyone.

I hope you are happy and well this Friday morning.

The sun is trying to come out here in Port-au-Prince.

Jonathan Katz's article this morning is here.

Please keep Haiti in your prayers today.

And for anyone researching Haiti's "situation", the following two articles are excellent:
Haiti's election chaos creates US dilemma
Kim Ives
Thursday 9 December 2010

On 7 December, Haiti's Provisional Electoral Council (CEP) announced the
deeply flawed 28 November general elections' "preliminary results". The top
three presidential candidates were former Senator Mirlande Manigat (31.37%),
ruling Unity party candidate Jude Célestin (22.48%), and former compas
performer Michel Martelly (21.84%). Abstentionist Haitians were the real
winners because only 1.087m, or 23% of Haiti's 4.7m registered voters,
turned out.

The announcement ignited a violent response from supporters of "Sweet
Mickey" Martelly, who had widely asserted that he was the leading candidate,
having "as much as 47% of the vote". Demonstrations and burning-tyre
bonfires immediately erupted in Pétionville, Cap Haïtien and Aux Cayes,
where numerous government offices and Unity partisans' houses have been

Supporters of Jean Henry Céant, the leading Faux-Lavalas candidate with
supposedly 8.18% of the vote, and nine other candidates, who have banded
with Céant in an informal front, have also held large demonstrations in
recent days calling for the election's annulment, the CEP's replacement and
Préval's resignation.

"The UN and the international community will never accept that a legitimate
Haitian president leaves under pressure from the street," responded UN
Mission to Stabilise Haiti (MINUSTAH) chief Edmond Mulet on 3 December. "It
would be a coup." Ironically, Mulet leads an occupation force that entered
Haiti following the February 2004 coup – backed by Washington, Paris and
Ottawa and involving "pressure from the street" – against "a legitimate
Haitian president" Jean-Bertrand Aristide. Over the past six years, MINUSTAH
has killed dozens of Haitians militating for Aristide's return. He remains
exiled in South Africa, and his Lavalas Family party, Haiti's largest, has
been barred from all post coup elections.

In fact, the current electoral fiasco is merely the 2004 coup's
continuation. Préval and Washington became bedfellows because both seek to
exclude Haiti's poor majority, who are overwhelmingly pro-Lavalas. But their
plot is failing, and, like thieves falling out, they increasingly distrust
each other, despite Mulet's profession of support.

Préval was one of the principal "enlightened bourgeois" to push Aristide
into the electoral ring 20 years ago, thereby becoming Aristide's first
prime minister. After Aristide's 2004 ousting, the US installed as de facto
prime minister Gérard Latortue, who, two years later, handed over to Préval,
a compromise candidate the Lavalas masses embraced because all their other
choices – like the late Reverend Gérard Jean-Juste – had been either jailed
or exiled.

This history is not lost on the US, as revealed in two confidential cables
from March 2007 and June 2009 just made public by WikiLeaks. As the then US
Ambassador to Haiti, Janet Sanderson, wrote:

"Despite his involvement in radical/communist circles as a student in
Belgium and his entrance into Haitian politics through a populist movement
deeply influenced by liberation theology, Préval's public and private
discourse is practically devoid of any notions reflecting that background."

She reassured Washington that Préval was "a neo-liberal", who "has embraced
free markets and foreign investment" and is "uninterested in ideology".
Nonetheless, Sanderson warned in 2009 that "Préval remains essentially a
nationalist politician … suspicious of outsiders' intentions and convinced
that no one understands Haiti like he does." Sometimes working "at cross
purposes with the US," riskily, he "believes that he can walk a fine line
without losing US or international community support."

This analysis is surely being re-read by current US Ambassador Kenneth
Merten, as Préval becomes more drag than lift to US policy in Haiti.

Last week, after three Haitian observer groups reported that Manigat and
Martelly were leading by 30% and 25%, respectively, to Célestin's 21%,
Préval's CEP told UN officials that it was considering a three-way second
round, according to a Haitian government source. UN officials vigorously
opposed the proposal and told Préval so. According to the source, a
high-stakes game of chicken then ensued, with Préval responding that, if
there could be no three-way runoff, then perhaps the election should be
annulled. (AP reports that bellwether OAS/Caricom mission head Colin
Granderson said a three-way runoff may be
case of a near-tie.)

In the hours before the CEP's announcement, there was a meeting at the
National Palace between Préval, the CEP, the UN and the US ambassador. It
may have been acrimonious, because the CEP's proclamation was delayed until
about 9pm, instead of 6pm, as foreseen.

As protests swept Haiti, Washington's embassy immediately issued a
disapproving statement that it would help "to thoroughly review
irregularities in support of electoral results that are consistent with the
will of the Haitian people". The US said it was "concerned" that the CEP's
results were "inconsistent" with those of the Haitian observers, among

So, here is Washington's dilemma. Does it heed Sanderson's 2009 conclusion
that "while we may argue with [Préval] about pace and priorities, we will
have to adapt to his rhythm" because he "remains Haiti's indispensable man"?
Or, now that his popularity has hit new lows following the 12 January
earthquake and the botched election, is he, in fact, dispensable?

As for Préval, Sanderson reported that "his overriding goal is to
orchestrate the 2011 presidential transition in such a way as to ensure that
whoever is elected will allow him to go home unimpeded," avoiding prison or
exile. Will he continue "stubbornly holding to ideas long past their shelf
life" and resist, "convinced that no one understands Haiti like he does"? Or
will he succumb to the pressures now sandwiching him from above and from the
streets below?

Both parties will want a compromise, unless the uprising worsens. The UN may
rubberstamp a CEP rule change to hold the three-way runoff, thereby
appeasing Préval and, hopefully, Martelly's mobs (although "Mickey" has
vowed not to share any runoff with Célestin).

Ambassador Merten is undoubtedly pondering Sanderson's prophetic conclusion:
"Managing Préval will remain challenging during the remainder of his term,
yet doing so is key to our success and that of Haiti."

From: Rachel Wallis



By Beverly Bell and Tory Field

December 9, 2010

As we file this article, Port-au-Prince is thick with the smoke of burning
tires and with gunfire. Towns throughout the country, along with the
national airport, are shut down due to demonstrations. Many are angry over
the government’s announcement on Tuesday night of which two presidential
candidates made the run-offs: Jude Célestin from the widely hated ruling
party of President René Préval and the far-right Mirlande Manigat. This is
another obvious manipulation of what had already been a brazenly fraudulent
election. A democratic vote is one more thing that has been taken from the
marginalized Haitian majority, compounding their many losses since the
earthquake of January 12.

What is at stake in Haiti? What interests underlie the grab for power in the
country? One answer is the large amount of aid and development dollars that
are circulating. Among those benefiting handsomely from the disaster aid are
U.S. corporations who have accessed U.S. government contracts. Below is the
tale of one U.S. corporation and its subsidiaries, who have received
contracts which involve both a conflict of interest and harm to one of
Haiti’s largest and most vulnerable social sectors, small farmers.

“We were already in a black misery after the earthquake of January 12. But
the rice they’re dumping on us, it’s competing with ours and soon we’re
going to fall in a deep hole,” said Jonas Deronzil, who has farmed rice and
corn in Haiti’s fertile Artibonite Valley since 1974. “When they don’t give
it to us anymore, are we all going to die?”

Deronzil explained this in April inside a cinder-block warehouse, where
small farmers’ entire spring rice harvest had sat in burlap sacks since
March, unsold, because of USAID’s dumping of U.S. agribusiness-produced,
taxpayer-subsidized rice. The U.S. government and agricultural corporations,
which have been undermining Haitian peasant agriculture for three decades,
today threaten higher levels of unemployment for farmers and an aggravated
food crisis among the hemisphere’s hungriest population.

Two subsidiaries of the same corporation, ERLY Industries, are profiting
from different U.S. contracts whose interests conflict. The same company
that is being paid to monitor "food insecurity" is benefiting from policies
that increase food insecurity. American Rice makes money exporting rice to
Haiti, undercutting farmers’ livelihoods, national production, and food
security. Chemonics has received contracts to conduct hunger assessments
and, now, to distribute Monsanto seeds.

Haiti is the only country in the hemisphere which is still majority rural.
Estimates of the percentage of Haiti’s citizens who remain small farmers –
or peasants, as they call themselves - are 66% to 80%.[1] Despite that, food
imports constitute upwards of 50% of what Haitians consume.[2] And still the
nation suffers under a dire food crisis, with more than 2.4 million of 9
million Haitians estimated to be food-insecure. Acute malnutrition among
children under the age 5 is 9%, and chronic undernutrition for that age
group is 24%.[3]

It didn’t used to be this way. In the early 1980s, Haiti was largely
self-sufficient in food consumption and was even an exporter nation. The
destruction of agriculture and food security came through policy choices. In
1986 and again in 1995, the International Monetary Fund (IMF) gave loans to
Haiti with the condition that the government reduce tariffs on goods
imported into the country. While previous tariffs on some staple foods had
been as high as 150%, by 1995 the Haitian government, under pressure
primarily from the IMF and U.S. government, cut import tariffs on food
basics to as low as 3%.[4]

Unable to compete with imported goods and thus unable to survive, Haitian
farmers have flocked into the overcrowded capital in search of a living.
They have joined the ranks of the underemployed or been welcomed by
sweatshops. And they have taken up residence in shoddily constructed housing
built on insecure lands, like ravines and the sides of steep mountains. The
devastating toll from the earthquake, with anywhere from 250,000 – 300,000
killed in and around Port-au-Prince, is in part due to farmers’ inability to
remain in their rural homes.

Rice is among the five most heavily subsidized crops in the U.S., with rice
growers receiving $12.5 billion in subsidies between 1995 and 2009.[5] The
subsidized production and the industrial scale, on top of the lowering of
import tariffs in Haiti, combined to become a money maker: beginning in the
early 1980s, rice grown in such places as Arkansas and California and
shipped by boat to Haiti could be sold cheaper than rice grown in a
neighboring field in the Artibonite Valley. With the U.S. television show
Miami Vice in high popularity during the time the threat to local producers
unfolded, Haitians named the imports ‘Miami rice.’

Between 1992 and 2003, rice imported into Haiti increased by more that 150%,
with 95% of the imports coming from the U.S.[6] The USA Rice Federation
claims on its website that 90% of the rice currently eaten in Haiti is from
the U.S.[7]

The flood of imported rice has shot up since the earthquake. In the
immediate aftermath of the disaster, USDA purchased 13,045 metric tons of
rice for Haiti.[8] In such a dire humanitarian crisis, even Haitian peasant
organizations who normally oppose food aid agreed that short-term assistance
was essential.

At the same time, however, locally grown food was and is available. “If the
foreigners want to give aid, it shouldn’t be food. We have the capacity to
produce. They should give us a chance to grow our own food so agriculture
can survive,” said Rony Charles, a farmer and member of the Agricultural
Producer Cooperative of Verrettes. But a supplemental aid bill in the U.S.
Congress – the Haiti Empowerment, Assistance and Rebuilding (HEAR) Act -
which, among other things, would have increased the percentage of food aid
purchased from Haitian producers, seems doomed because of Republican
opposition. Advocacy groups in Washington such as Haiti Reborn will work to
get the bill reintroduced in January, but it is unlikely that any local
procurement will happen for several years.

ERLY Industries is one U.S. corporation that amply benefits from aid and
trade opportunities in Haiti. ERLY is the parent company of American Rice,
which has been selling rice in Haiti since 1986 via its Haitian subsidiary,
the Rice Corporation of Haiti. By the mid-nineties, American Rice was
importing 40-50% of all rice eaten in Haiti.[9] A press release by the USA
Rice Federation, of which American Rice is a member, referred to the
federation’s “collaboration” and “proactive efforts” with USDA and USAID in
getting rice to Haiti just after the earthquake.[10]

Chemonics, another subsidiary of ERLY Industries, has been running two
USAID-funded projects since before the earthquake and received one of the
first post-disaster contracts in Haiti, for $50 million from USAID. Chemonics
gets 90% of its funding from USAID and works in more than 75 countries.[11]
One of Chemonics’ focus areas is agricultural work, with many projects aimed
at developing international trade opportunities. Chemonics has also been a
large beneficiary of USAID contracts in the wars in Iraq and

One of Chemonics’ pre-earthquake contracts in Haiti, as in other countries
around the world, (2006-2010) is the USAID-funded Famine Early Warning
Systems Network. FEWS NET II, as it is known, monitors food security and
reports on such issues as food prices, climate, and market flows.

Chemonics also holds a $126 million USAID contract for 2009 through 2014 for
its Haiti-based Watershed Initiative for National Natural Environmental
Resources (WINNER). Some of WINNER’s stated contract goals include increased
agricultural productivity, strengthened watershed governance, and reduced
threat of flooding.

WINNER now has a new role of distributing Monsanto’s recent donation of 475
tons of hybrid corn and other vegetable seeds throughout Haiti. While this
year’s seeds were free of charge, farming advocates familiar with Monsanto’s
history around the world consider the donation a Trojan horse, with Monsanto
seeking to gain a foothold in the Haitian market. The full extent to which
Monsanto will now join Chemonics and American Rice as economic beneficiaries
of the earthquake remains to be seen. Elizabeth Vancil of Monsanto gave
“special thanks to USAID and USDA, who connected us to be able to secure
this approval.”[13]

Meanwhile, Haitian peasant groups have declared this donation an affront to
their seed sovereignty, which they refer to as “the patrimony of
humanity.”[14] Among other problems, they point to the Calypso tomato seeds
being treated with Thiram[15], a pesticide additive so toxic that the EPA
has banned its use for home gardeners in the U.S.[16] On June 4 for World
Environment Day, more than 12,000 Haitian farmers and allies marched in a
rural town and burned Monsanto seeds. In the U.S., solidarity groups from
Chicago to Seattle did the same.[17] Doudou Pierre, a leading food
sovereignty advocate, said that the June 4 action was “a declaration of

In March, Bill Clinton formally apologized for his role in having promoted
the import of U.S. rice into Haiti at the expense of Haitian farmers. "It
may have been good for some of my farmers in Arkansas, but it has not
worked. It was a mistake… I had to live everyday with the consequences of
the loss of capacity to produce a rice crop in Haiti to feed those people
because of what I did; nobody else."[18] Mea culpa notwithstanding, nothing
has changed in U.S. foreign aid and trade policies.

As for the March rice harvest grown by Jonas Deronzil, Rony Charles, and
other producers in the Artibonite, it finally sold in June for almost
exactly two-thirds of what it would have brought in before the earthquake:
US$13.27 a sack versus US$20.77.

“It’s not houses which will rebuild Haiti.” said Rosnel Jean-Baptiste of the
national organization Heads Together Small Peasants of Haiti. “It’s
investing in the agricultural sector.”


*Beverly Bell has worked with Haitian social movements for over 30 years.
She is also author of the book Walking on Fire: Haitian Women's Stories of
Survival and Resistance. She coordinates Other Worlds,, which promotes social and economic
alternatives. She is also associate fellow of the Institute for Policy

*Tory Field is an organizer, farmer, and Program Associate at Other Worlds*


*[1] The CIA claims 66% (CIA Factbook, 2010,
while Haitian peasant farmer organizations typically use a figure of 80%.

[2] A recent Associated Press article cited a 2005 government needs assessment
which put the figure at 51% (Jonathan Katz, “With cheap imports, Haiti can’t
feed itself,” Associated Press, March 20, 2010).

[3] World Food Program, 2010,

[4] Oxfam International, “Kicking Down the Door: How Upcoming WTO Talks
Threaten Farmers in Poor Countries”, April 2005, p. 26.

[5] Environmental Working Group Farm Subsidy Database,
[6] Oxfam International, Op. Cit., p. 26.

[7] USA Rice Federation, “USA Rice Efforts Result in Rice Food-Aid for
Haiti,” January 20, 2010.

[8] Ibid.

[9] Lisa McGowan, “Democracy Undermined, Economic Justice Denied: Structural
Adjustment and the Aid Juggernaut in Haiti,” Development Group for
Alternative Policies (The Development GAP), January 1997.

[10] USA Rice Federation, Op. Cit.

[11] Center for Public Integrity,

[12] Ibid.

[13] Email from Elizabeth Vancil, Op. Cit.

[14] See, for example, the declaration of Chavannes Jean-Baptiste, director
of the Peasant Movement of Papay, “Monsanto in Haiti?”, distributed by email
on May 14, 2010.

[15] Email from Elizabeth Vancil to Emmanuel Prophete, Director of Seeds at
the Haitian Ministry of Agriculture, and others; released by the Haitian
Ministry of Agriculture, date unavailable.

[16] Extension Toxicology Network, Pesticide Information Project of
the Cooperative
Extension Offices of Cornell University, Michigan State University, Oregon
State University, and University of California at Davis,

[17] Beverly Bell, “Groups Around the U.S. Join Haitian Farmers in
Protesting ‘Donation’ of Monsanto Seeds,” June 4, 2010,

[18] From a statement to the Senate Foreign Relations Committee on March
10th, 2010. Jonathan M. Katz, “With cheap food imports, Haiti can't feed
itself,” Associated Press, March 20, 2010.*

Rachel Wallis
Other Worlds
Media and Education Coordinator

Thursday, December 09, 2010

Daylight-- December 9, 2010

12 year old Zenden with severe cholera. He had no palpable radial or brachial pulses and his arms and legs were cold. Zenden survived. (Photo by John Carroll)

This morning Port-au-Prince was covered by clouds and a light drizzling rain (farinen). But at least it was light again.

When I asked the nurses at the Cholera Treatment Center (CTC) if the sun was going to come out today they said they didn’t know, and one nurse said that "Haiti is crying".

Haiti should be crying after the last several days.

The nurses also told me that the streets were still bad this morning. A lot of rock throwing in Tabarre. And tires on fire here and there. And downtown Port-au-Prince was bad as usual.

The Port-au-Prince International airport is still closed. American Airlines employees can’t make it to work because of the streets, and if airlines passengers did arrive, where were they to go? The roads are blocked.

The good news is that we did not lose any cholera patients last night. I thought that three patients could have died late last night, but somehow they pulled through. (Two of the three appeared deceased last night when I checked on old man and a 24 year old girl lying on cots next to each other. Both got fluids poured into them.)

A few more very sick patients came in this morning including a three year old sweet and brave little girl with no palpable pulse who started vomiting at 5 AM this morning. The vomiting was followed by profuse diarrhea. She was sleepy between IV sticks which made me worry.

And an unresponsive 19 year old girl who was brought in by her mother. She had been sick for less than 24 hours.

Both patients were quickly bolused with IV solutions and both woke up.

The quantity of our IV solution remains a big concern to me. Are we going to have enough of this life saving fluid as the days go by? Do we need to ration it when it shouldn’t be rationed?

I discussed or IV fluid problem with my wife Maria yesterday via e mail and Maria was able contact an assistant of Senator William Frist, MD regarding our CTC’s lack of sufficient IV Ringers. After several e mails the assistant told Maria that Senator Frist would work on improving our supply! (The WHO was unable to deliver IV solution again today to the CTC due to the barricades in the roads.)

I have noticed that the cholera patients in our CTC that have the “best” families seem to do the best. Their cot areas are cleaned better by the family, their multipurpose bucket is frequently dumped and cloroxed, and the family will offer them oral rehydration solution more frequently. The patients with good family support also notify staff if the IV solution is ready to run dry.

The unfortunate patients whose family is not constantly present don’t do as well, especially if they are kids. They just don’t get the attention that they need and can start to swirl downwards.

This afternoon I called my motorcycle chauffer and he came to the CTC to get me to take me back to the guesthouse.

We returned going down Route National 1. He drove very fast.

There were very few cars on Route National 1 but more people were on the streets than yesterday. Women were selling vegetables on sidewalks and men were soldering like a fairly usual day.

There were no burning tires but as we approached Sarthre, which is a zone in LaPlaine, the road was soot black for about a quarter mile where many tires had been burned yesterday.

It so so sad to see this deadly societal disarray.

The Haitian people are very angry over the fraudlent (magouya) election results. So they take it out on someone. Right now they hurt each other by stopping the flow of the day and travel everywhere in the country.

And if their barricading and violence hurt the business guys too much it would be stopped. But it doesn’t, so the disarray goes on for a while, and more poor people are denied basic needs (like medical care).

And the cycle continues...

Wednesday, December 08, 2010

Haiti's Dark Night--- December 8, 2010

Photo by John Carroll

I just left the Cholera Treatment Center (CTC).

It is 9:15 PM.

The CTC takes on a new look after the sun sets.

A pastor came into the CTC tonight and preached as many family members huddled around their loved ones and sang religious songs. The patients that I gave enough fluid to today, slowly waved both hands in the air thanking God that they survived another day. The patients still low on fluids, just stared at what was happening around them.

This morning I was able to get from my guesthouse to the CTC on a motorcycle driven by a very skilled operator.

We maneuvered through the back roads of Laplaine and onto Route 9 for a couple of miles. Only one car was on Route 9 as we headed north.

We turned onto a dirt road when we reached Siebert and went about a mile. Some men stopped us and kindly informed us that there we were going to run into a road block up ahead and so we should be ready.

My motorcycle chauffer stopped for a few minutes but we decided to press forward.

As we went further down the road, we could see a group of men were piling stones on the road and tires were on fire in front of us. So we turned around and went back several hundred yards and considered the plan again.

A middle aged Haitian man named Caleb approached us as we were gathering our thoughts and said that we would have no problem passing the barricade down the road and to go with him. So we drove slowly as Caleb marched along side of us.

Caleb calmly told us to get off the motorcycle as we neared the men. We did what he said and walked through a field on the side of the road with the motorcycle. We kept Caleb in our view as he stayed on the road.

Caleb motioned for us to come back to the road.

Men were rolling more tires to the fire and Caleb explained to them that I was going to the CTC (I won't name which one) and to let us through.

They didn't bother us at all and we jumped back on the bike and drove around the burning tires and rock barricade in the road.

Acutally, my driver was lost at that point, but I recognized where we were and with a few questions of people sitting on their stoops, we arrived at the CTC in fine fashion.

The CTC was actually inundated with typical cholera patients. The cholera doctor who usually works the clinic did not try to make it to the CTC because of the street violence today. Only two of our four nurses showed up today, but two other nurses were recruited from the adjacent hospital.

Our CTC is very short on IV Ringer's solution. And I think that we get behind on our patients. By that I mean, I think that we are not hitting them as hard as we should with enough IV fluid because we are trying to ration the IV solution. And no matter how much I holler about drinking oral rehydration solution to the patients and their families, this is hard to make happen for many reasons.

We need more IV solution quickly. Many of these cholera patients are in shock and they need lots of fluid very fast. If they get the fluids, they survive.

Two of my patients today are Haitian-Americans. One is very ill with a systolic blood pressure of 60 mm Hg.

As the sun was starting to go down late this afternoon, I called a couple of Haitian contacts and they told me not to come back tonight because of the disorder on the streets in Port-au-Prince.

So I am holed up in an on-call room in the local hospital and the Haitian physician on call here is kind enough to let me use his laptop.

The World Health Organization could not deliver IV solution to us today. Bottom line, more IV fluids need to come in to this CTC very quickly or many lives will be lost that should not be lost.

Port-au-Prince was shut down today by fear.

The political unrest and violence in Haiti is hurting everyone, especially these fragile cholera patients.

The NYT's published this article today.

Disorder in Port-au-Prince This Morning--December 8, 2010

Photo by John Carroll
December 7, 2010

The situation here in Port-au-Prince is not good this Wednesday morning.

See this article.

The violence over the rigged elections hurts so many people today who are just trying to do the right thing. Most people just want to do their "little jobs" today and try and provide for their families one more day.

And sick people are afraid and may wait until they seek medical help. Sick cholera patients need IV fluids right away and cannot wait.

Tuesday, December 07, 2010

No One Cries When An Old Man Dies of Cholera in Haiti

Photo by John Carroll

This old man died at the Cholera Treatment Center yesterday.

Please read Jonathan Katz's article below.


Haiti cholera likely from UN troops, expert says
JONATHAN M. KATZ, Associated Press

Published: 01:58 p.m., Tuesday, December 7, 2010

PORT-AU-PRINCE, Haiti (AP) — A contingent of U.N. peacekeepers is the likely source of a cholera outbreak in Haiti that has killed at least 2,000 people, a French scientist said in a report obtained Tuesday by The Associated Press.

Epidemiologist Renaud Piarroux concluded that the cholera originated in a tributary of Haiti's Artibonite river, next to a U.N. base outside the town of Mirebalais. He was sent by the French government to assist Haitian health officials in determining the source of the outbreak, a French Foreign Ministry official said Tuesday.

"No other hypothesis could be found to explain the outbreak of a cholera epidemic in this village ... not affected by the earthquake earlier this year and located dozens of kilometers from the coast and (tent) camps," he wrote in a report that has not been publicly released.

The report also calls for a further investigation of the outbreak, improved medical surveillance and sanitation procedures for U.N. peacekeeping troops and better support for Haitian health authorities.

The AP obtained a copy of the report from an official who released it on condition of anonymity. Piarroux confirmed he had authored the report but declined in an e-mail interview to discuss his findings. Copies were sent to U.N. and Haitian officials, the foreign ministry confirmed.

U.N. spokesman Martin Nesirky told reporters in New York that there is still no conclusive evidence that its base was the source of the outbreak. He said the organization "remains very receptive to any scientific debate or investigation on this."

The report's revelation comes on a day of high tensions in Haiti, as people anxiously await the results of the disputed Nov. 28 presidential election and potential resulting violence.

Piarroux could not prove there was cholera inside the base or among the soldiers, a point the U.N. has repeatedly used to deny its soldiers brought the disease to Haiti or that its sanitation procedures were responsible for releasing it into the environment. He writes that military doctors said there were no instances of cholera within the unit.

But he also hinted strongly at a cover-up.

"It can not be ruled out that steps have been taken to remove the suspected fecal matter and to erase the traces of an epidemic of cholera among the soldiers," he wrote.

The report also notes that septic tanks and pipes that would have helped to confirm sanitation problems and the presence of the bacteria were no longer at the base when he visited.

Nepalese troops earlier confirmed they had replaced a leaking pipe, which contained a foul-smelling runoff that the U.N. denies was human waste, between two visits by an AP reporter in October. The AP also found the local contractor dumped waste into overflowing pools dangerously close to a hillside that drains into the river.

Piarroux's is the first scientific report linking the base to the epidemic, though many other epidemiologists and public health experts have said for weeks that the soldiers are the most likely source of the infection.

Other scientists and experts say it is possible that ocean currents or other climate-related events carried the bacteria to Haiti. Further studies on bacterial samples that could address those questions are ongoing.

The U.S. Centers for Disease Control and Prevention confirmed in October that the strain of cholera bacteria in Haiti matched one from South Asia, a region that includes Nepal, but said it had no further information about the cause of the outbreak at the time.

Many Haitians have long suspected the Nepalese base was the source of the disease, and anger at the troops sparked a week of riots in which U.N. soldiers were injured and several Haitians were killed.

The report says that the first cases of the disease were from the village of Meille, where the base is located. The first confirmed case, a 20-year-old man from the village, developed symptoms on Oct. 14 and was found by Cuban doctors at a hospital in nearby Mirebalais.

Haitian investigators "indicated that the first patients were obtaining drinking water from a tributary of the Artibonite River flowing just below the (U.N.) base," he said.

It notes that the rotation of soldiers began arriving days before those first cases from Nepal, where there were cholera outbreaks over the summer.

It goes on to describe how the disease flowed into the Aribonite River before "exploding" in the delta where the river meets the sea. Hundreds of cases were reported within days, before the outbreak spiraled out of control to infect the entire county.

Until this outbreak there had not been a diagnosed case of cholera in Haiti as far back as records go in the mid-20th Century, Claire-Lise Chaignat, head of the global task force on cholera control at the World Health Organization, said in October. There were suspected cases a century before, but experts say it would have likely been a different strain than the ongoing El Tor pandemic.

The disease was totally unknown to today's Haitians, who had developed no immunity against it and had no information on how to fight it until aid workers mobilized after the outbreak. Terror over its fast-killing power has triggered attacks on cholera treatment centers and a witch-hunt in rural Haiti. At least 12 people were killed on accusations they used magic to spread the disease.

For the first critical month of the outbreak, the United Nations, U.S. Centers for Disease Control and Prevention, World Health Organization and others said that an investigation into how the disease arrived in Haiti was not necessary and could in fact be harmful. Those who asked questions about it were accused of playing "the blame game."

It was not until AP reports of sanitation problems at the base and calls by experts including Paul Farmer, a physician and U.N. official, for a thorough investigation that the matter was seriously discussed in public.

Farmer said there were compelling public health reasons to find the source of the infection, including finding information to help prevent its further spread, and that avoiding the questions was a matter of politics.

The U.N. mission confirmed to AP last month that a French epidemiologist had met with met with U.N. peacekeeping mission chief Edmond Mulet in Port-au-Prince to discuss his findings. At the time the mission denied that he had implicated the peacekeepers, but acknowledged that it was now taking the allegations about its base more seriously than when rumors first arose.

On Tuesday the mission said the report was still not definitive.

"We have neither accepted nor dismissed his findings, as it's one report among others," U.N. mission spokesman Vincenzo Pugliese said. "The Nepalese contingent in Mirebalais is just one piece of the cholera puzzle, since there is no conclusive evidence at this point that the Nepalese camp was or was not the source of the epidemic."

In roughly six weeks the disease has spread to every region of the country and sickened nearly 100,000 people. The U.N. says the death toll could be twice the official count and that up to 650,000 people in Haiti could get cholera over the next six months.


Associated Press writers Angela Doland in Paris and Edith Lederer at the United Nations contributed to this report

Attack Rate of Cholera Still Going Up

See this article. It explains things very well from the inside of a Cholera Treatment Center.

Renaldo's Obituary


Born April 4, 2010--Died December 6, 2010

Renaldo, eight months old, of Bon Repos, Haiti was pronounced dead at 9:05 AM this morning at a Cholera Treatment Center in Port-au-Prince, Haiti.

Renaldo was the son of his Papa and Mama who were present at his death.

Renaldo was admitted to the Cholera Treatment Center yesterday with his mother who is also a patient there. She witnessed his death lying on a green cholera cot just a few feet away.

Renaldo is survived by his two older siblings and his loving aunt in Bon Repos, Haiti.

The family loved Renaldo. His expressive eyes and smile wrapped everyone up with happiness.

His family would like to thank all who cared for him during the last 24 hours of his life, especially his aunt, who is also the primary caregiver to Renaldo’s mother.

Minutes after Renaldo’s death, oral rehydration solution was used to baptize him on his sweet forehead. His body was wrapped in the usual fashion after a cholera death in Haiti and taken to an undisclosed location.

There will be no memorial services.

Monday, December 06, 2010



Please meet Widnerlande.

I will call her "W".

W is six years old and Haitian Hearts is taking her to California next week for heart surgery.

Maria and I first "discovered" her six years ago at a pediatric clinic in Laplaine. She had a loud heart murmur and a subsequent echocardiogram revealed a ventricular septal defect (VSD) which is a hole between the lower chambers of her heart which should not be there. This hole allows blood to flow the wrong way each heart beat and this is hard on heart and lungs.

VSD's are the most common congenital heart defect.

Maria has a friend in California and both were able to persist and find a pediatric heart surgeon and medical center to operate W.

W lives in the Artibonite with her mother. W has five brothers and sisters. Three of her brothers and sisters are in two different orphanages.

On January 12 the earthquake knocked over her house, so her mom and grandfather built a small room out of rocks. W lives in this room with her two remaining siblings and her mother and grandfather. They have a dirt floor, no water, and no electricity.

W appears quite good for what she has gone through. She is very playful and seems quite intelligent. However, her hair has an orange tint which is evidence of protein malnutrition. Her mother just cannot afford meat and eggs for W.

I asked her mother yesterday if she had W's vaccination card. Mother said it was lost several years ago during the hurricane season when four tropical storms or hurricanes flooded her home.
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Sunday, December 05, 2010

Vengeance on Dark Souls

These are a few anecdotes and statistics that I have jotted down during the last few days. They are all related to each other in some obtuse fashion.

I examined a 60 year old lady in the Cholera Treatment Center (CTC) a couple of mornings ago. She had no pulse that I could feel at her right radial or brachial areas. I could feel a slight pulse at her right femoral artery which meant that she had a blood pressure of at least 40 mm Hg. I was not able to take her blood pressure in her arm at all.

After my exam I was staring down at her on her cart and she looked at me and thanked me even though her brain was not getting a "full head of steam" with her low blood pressure. I had no idea how she could even talk let alone thank someone.

Two lines were started in her left wrist and her right saphenous vein by the ankle and she perked up in an hour. However, she was febrile with her new circulatory status and had a tender abdomen, so I transferred her out of the CTC. I had bad feelings about more was going on than "just cholera".

We had an 18 month old boy with pretty severe cholera. He also had an hour of seizures off and on, which is called status epilepticus. The CTC where I work has no medication at all except Ringer's Lactate IV fluid. People with cholera, especially children, can become hypoglycemic with cholera. Their sugar can become so low that they seize. So we started some Dextrose solution along with the Ringer's Lactate and his seizures stopped, he woke up, and started eating. Hypoglycemia is a poor prognostic indicator but he sure looked good the next day.

One of the Haitian nurses I work with lives in a tent. She has lived there with her family every since their house collapsed in the earthquake. She comes to work everday to the CTC in immaculate condition. Her clothes are pristine and she has a smile on her face. What about that?

The definition of cholera that we use here is greater than or equal to three liquid stools within 24 hours with or without vomiting. We use no lab tests to diagnose it and draw no other labs. We treat as fast as we can, especially the severe cases with IV fluids running wide open.

I had a middle age man a couple of days ago who was completely out of it with tenting of skin and he had a heart rate of 144. He had been sick for about 18 hours. Fluids were run in quickly through two lines and he woke up and waved both arms in the air as Haitians do thanking God.

Some rough statistics re cholera:

About 80% of people with cholera are asymptomatic. That leaves 20% symptomatic. Of the symptomatic 20%, approximately 80% of them can be treated with oral rehydration solution (ORS). Only the remaining 20% need IV fluids.

For a CTC of 200 beds, about 160 employees are needed.

One should never run out of supplies in a CTC. Ringer's Lactate is life saving and so are good nurses. I worry about Haiti and lack of IV solution.

Each bad cholera patient needs about 60 liters of potable water per day.
Start cholera patients drinking with IV still in. And a severe cholera patient can lose his entire body weight in fluids in several days!!

I saw this on the back of a guy's tee shirt outside the CTC the other day: "Vengeance on Dark Souls".

"Je we, bouch pe." (What the eyes see, the mouth is afraid to say.)

Reporting systems are poorest in countries like Haiti, where cholera is highest.

"Lajan vire loloj." (Money twists the mind.)

I have noticed that my patients with cholera breathe fast. I think this is due to the fact that they have a metabolic acidosis and are "blowing off their carbon dioxide" to compensate for their acidosis.

Patients may present after only a few hours of illness with massive volume loss of between 500 and 1000 mL per hour, and rapidly can lose more than 10 percent of their body weight. In patients treated with proper rehydration, diarrhea is most severe during the first two days and then ends after four to six days.

The mortality of cholera in untreated patients may reach 50 to 70 percent. In areas endemic for cholera, the mortality risk is increased in children (ten times greater than that in adults) and in pregnant women, who also have a 50 percent risk of fetal death during the third trimester. Patients can die within two to three hours of the first signs of illness, although death in untreated patients usually occurs after 18 hours to several days.